ICD-10 END TO END TESTING & MORE 5/12/15 Mark Guillot, PMP Stefanie Womble, PMP
Agenda End to End Testing Purpose End to End Testing Visual CMS Process Example Commercial Process Example Preparation for ICD-10 Code Change Visual
Purpose of End to End Testing The purpose of the End-to-End Testing is to ensure that critical systems (internal and external) are able to accept and transmit the appropriate data in an ICD-10 format from data entry to final payment. End-to-End Testing must also perform a variance analysis on the final payment.
Technical Financial
Knowledge Readiness Refers to ensuring every person on the path knows about ICD-10 at the appropriate levels Some Examples: Physician Coder Billing A/R
System Testing System testing refers to ensuring that your system(s) is/are ICD-10 compliant and that your users are trained to use the system. If you haven't already contacted your vendor, do it very soon as their resource availability is rapidly decreasing. Other areas to test include forms, reports, extracts, and interfaces
Path Readiness Refers to knowing the current path of your claims and your remits; also ensure every organization on your path is ICD-10 ready. Provider Payer Clearinghouse Clearinghouse Provider
Clearinghouse Readiness If you use a clearinghouse: - Are they ICD-10 compliant? - Do they have a test portal? - Will they receive 835/UB/1500 from the payers or will they require you to receive directly from the payer?
Payer Readiness Gather a list of all your payers Rank them based on revenue Contact them now to request testing Get requirements early! - Mock patients? - Mock scenarios? - Spreadsheet testing? - Full End-to-End testing?
Variance Analysis Document what you send to the payer for testing Once remit is received, match remits and determine if there is a variance in payment Perform root cause on the variance - Understand if the variance is positive or negative Update your training and or policies
CMS Testing Processes 1. Admit the patient 2. Coder Code the scenario using ICD-10 3. Claims Generate ICD-10 Claim, submit 837 4. Clearinghouse Hold claim for CMS scrape 5. CMS Process claim, submit 835 6. Provider Analyze 835, root-cause (if necessary)
Sample Testing Process Payer Test Region Send Remit Data
Codes Overview Outpatient and office procedure codes aren t changing. The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding. Your practice will continue to use CPT. You will use a similar process to look up ICD- 10 codes that you use with ICD-9.
Preparation Your practice uses certain codes but not all. Run system reports to identify top codes in ICD-9 12 months if cyclical List commonly used codes Associated ICD-10 codes to DX text Update annually by CMS new codes published Aug/Sept for use starting Oct 1st
Fee Slip/Charge Slip/Fee Ticket Area with ICD-9 codes
Fee Slip Example Portion of New Fee Slip CMS Info
ICD-10 Documentation Essentials Laminated Cheat Sheet
ICD Code Structure Comparisons
Implementation Prep 1. Create team 2. Tracking financials: A/R, etc. Timeline take snapshot of A/R now (by payer) Go-Live: 10/1/15 Re-review post ICD-10 3. Go-live Response Planning Contact list: vendors, clearinghouse & payers Plan time for handling denials from payers
ICD-10 Monitor Talk Ten Tuesday: April 21, 2015 Finance and Revenue Cycle Comparing ICD9 to ICD10 Pay less than in the ICD9 world Optimize documentation Codes affected: Cardiology: 40 Neurosurgery: 18 Orthopedics: 16 http://www.icd10monitor.com/
QUESTIONS?
APPENDIX
ICD-10 Code Structure
ICD-10 Codes ICD-10-CM is for use in all U.S. health care settings. Diagnosis coding under ICD- 10-CM uses 3 to 7 digits instead of the 3 to 5 digits used with ICD-9-CM, but the format of the code sets is similar. CM=Clinical Modification Use for diagnosis coding ICD-10-PCS is for use in U.S. inpatient hospital settings only. ICD-10-PCS uses 7 alphanumeric digits instead of the 3 or 4 numeric digits used under ICD-9- CM procedure coding. Coding under ICD-10-PCS is much more specific and substantially different from ICD-9-CM procedure coding. PCS=Procedure Coding System Inpatient Procedure Coding
Sources http://www.cms.gov/regulations-and-guidance/hipaa-administrative- Simplification/Affordable-Care-Act/End-to-End-Testing.html http://www.cms.gov/medicare/coding/icd10/index.html http://www.cms.gov/medicare/coding/icd10/downloads/icd10introduct ion20140819.pdf
Contact Information Mark Guillot mark.guillot@bannerhealth.com Stefanie Womble stefanie.womble@bannerhealth.com