Qualedix QA and the North Carolina Healthcare Information and Communications Alliance (NCHICA) are piloting an end-to-end ICD-10 testing framework and a trading partner certification program. This pilot represents a shared work effort focusing on test data, testing and trading partner coordination, with clinically accurate test data at its core.
NCHICA has involved more than a dozen participants across all stakeholder groups and is helping address the needs of their members by sponsoring this important testing effort. Making this a community-based effort falls directly in line with the approach that it takes a village to perform end-to-end testing the correct way, from encounters to reimbursement.
A major outcome of the pilot is that it creates a shared test bed to which all NCHICA participants will have access, including vendors, providers, billing companies, clearinghouses and health plans. This enables the group as a whole to have clear expectations of the test conditions and desired outcomes. The known outcomes also provide the key mechanism required to help identify errors occurring from the beginning to the end of the testing life cycle.
The NCHICA pilot is broken out into four phases: internal coding, internal testing, trading partner testing and finally end-to-end testing. Trading partner and end-to-send testing are viewed as separate and distinct test phases, whereas the former would test the supply chain and the latter would test final outcomes.
There are currently multiple institutional providers dual-coding unique clinical transactions across multiple specialties using test cases from the top three DRGs from each provider, ensuring that tests are relevant to provider and payer alike. The clinical documentation is peer-reviewed by all internal teams and also by external coding organizations, ensuring the greatest possible consensus on ICD-10 coding and DRG assignments. Test cases focus on knee replacements, lymphoma, septicemia, epistaxis, lap band procedures, cardiovascular matters and many other types of conditions and procedures.
The internal coding and peer-review phase, while time-consuming, has been proceeding very smoothly, with only minor revisions to codes and documentation to make them ICD-10-ready. While it may seem at first blush that ICD-10 testing might be daunting to a single facility, it becomes much more manageable under a collaborative approach since the range of expertise is greater across multiple organizations. The test cases will be sent to the health plan and clearinghouse participants by September for their review and mapping comparisons. By getting provider-based test cases in the hands of the health plans early and often, more thorough and more accurate testing can occur.
Visibility is required by all healthcare stakeholders into every other stakeholder’s readiness level, and this cannot be determined within a testing silo, as the industry has learned during the recent 5010 testing efforts. We look forward to sharing a successful case study upon completion of each testing phase, hopefully enabling other healthcare communities to share similar successes.
About the Authors
Mark Lott is the CEO of Qualedix QA Services, Inc. Mr. Lott’s 25 year career in software testing and quality assurance expertise in healthcare, pharmaceutical and banking has led to the development of cutting edge testing methodologies and end-to-end testing platform for ICD-10. Mark’s career as a successful entrepreneur and executive includes his role as Chairman of HCCO (Health IT Conformance and Certification Organization) where he architected the first HIPAA interoperability testing methodology called CCAP (Common Conformance Assessment Program) for 4010 and certified the majority of EDI validators and translators in use today.
Christian Omba currently serves as the ICD-10 Program Manager for Rex Healthcare, where he is responsible for the implementation of people, process and technology solutions to meet the ICD-10 regulatory requirements. Christian is a 25-year veteran of Business Operations and Technology management. He has successfully led a variety of industries to meet regulatory compliance, technology optimization, resource optimization, and legal requirements.
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