End-to-end testing for ICD-10 readiness

When you’re connecting systems across multiple departments and stakeholders for the introduction of a new code set, anything could go wrong. In preparation for ICD-10 implementation, stakeholders on both sides of the coding scenario should be fully prepared — end-to-end testing is necessary and must be meticulous. It replicates an organization’s systems to assess operational readiness and note any potential hiccups or unexpected outcomes prior to implementation.

Testing and transparency among partners

Like providers who will want to avoid unexpected claim rejections and budget overruns, payers will want to test their ability to receive, adjudicate and pay claims in ICD-10 so that business outcomes are consistent and predictable.

It will be particularly important to prioritize the following aspects of testing, as they could directly impact payers’ ability to successfully communicate with and appropriately reimburse provider partners:

  • Transaction testing: Transaction testing, perhaps the most obvious part of testing, can help ensure all operational areas are ready for production, including care management programs and authorizations, claims intake and reimbursement, benefit policy assignment, and fraud and abuse identification.
  • Claims transparency: Claims rejections prolong the time between date of service and receipt of the claim, making it difficult for payers to see the actual cost incurred and obscuring reimbursement patterns. We recommend working with providers during end-to-end testing to look for ways to reduce claims rejections. Transparency will also help assuage any fears from providers that payers will not be reimbursing correctly or adequately.
  • Neutrality or outcomes testing: Although there may be changes in coding and reimbursement driven by ICD-10, neutrality testing can reveal changes in reimbursement or other business rules that are driven by ICD-10, so that those impacts can be prevented or predicted and unintended financial consequences can be identified and planned for. Make sure the information you received from your trading partners is accurate and what you expected, and that what you sent back to the partner is what they expected from you and is accurate. This type of testing can also reveal whether, in instances where one code in ICD-9 translates to 12 codes in ICD-10, the financial outcome is the same in ICD-10 as it would have been in ICD-9. Successful testing includes a carefully planned approach on test data. Although not every claim scenario can be tested, focus on using the 80/20 or Pareto rule (selecting the 20% of claims data that drive about 80% of your business).

Testing amid daily operations

How does a payer go about testing systems while keeping up with the day-to-day work of the organization? “In truth, many organizations will have difficulty finding resources, whether financial or human, to set up that type of testing arrangement.

To overcome this interference, it’s important for the organization’s testing and operations teams to work together to set up a structure that replicates the system, and to coordinate resources that might otherwise be in contention. By replicating the system, payers can test in the replicated system while doing the day-to-day work in the original system. Careful planning for how to move a chunk of information through outside firewalls, into your system and through staff should take into account staff workflows and timelines for daily work.

It will also be important for organizations to remember that testing will continue even after the ICD-10 live date because payers and their provider partners will want to continue to monitor the system to make sure that what is happening in real-time is what was expected during testing and that processes are working correctly.

Want more information on ICD-10 implementation? Download the Optum white paper, “Making the Health System Work Better for Everyone: The ICD-10 Collaboration Imperative."