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1. ICD-10 Testing - Lessons Learned
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2. Introduction
2
Yaron Kottler
• Sr. Test Specialist & CEO
Tom Parnon
• Director Business
• Development

3. Agenda
• Lessons learned
• Testing challenges
• Solution overview
• Self assessment
• Q&A
3

4. What is your organization’s overall approach to
ICD-10 testing?
Conduct an ICD-10 impact assessment…
4
Survey Question #1:
40%
35%
30%
25%
20%
15%
10%
5%
0%
But don’t test & internal testing
only
& comprehensive
internal & ext. rev
impact testing
Other
12%
18%
35% 35%

5. Lessons Learned
• Some organizations mistakenly believe impact
assessments are sufficient for revenue impact analysis
• A comprehensive ICD-10 testing effort will require tens
of thousands of encounters based on a core dataset of
250 – 5000 medical records
• IT and revenue cycle departments are struggling to
secure internal cooperation from medical coders for test
data creation
• Data DE identification is Key
• Data Contextualization cannot be avoided – Both
content and correlation
5

6. Lessons Learned
• Test Automation is extremely effective for core
processes such as Registration, charting and coding
• Automation will not replace exploratory testing, just
simplify the setup activities
• Ancillary systems and processes are better tested
manually
• End to End ICD-10 testing does not eliminate the need
for comprehensive regression testing
• An integrated test environment is essential.
• Fat clients simplify the test automation effort
considerably
6

7. Lessons Learned
• Some payers are not cooperating, others are insisting on
running the show.
• Some Payers utilize provider specific impact
assessments and actual medical records (MRNs)
• Some regionsstates have active ICD-10 collaboratives
• Most providers have been slow to reach-out to their
most important payer partners to establish a joint
approach
• The solution offered by the ICD-10 national testing
program completely neglects to cover areas such as
internal testing and revenue impact testing.
7

8. QualiTest
• World’s 2nd largest pure play independent testing
company and the largest in the USA (Nelson Hall – 2012 & 2013)
• Over 1,600 testing professionals world wide
• QA & Testing focus - QA & testing is all we do!
• Strong focus on the Healthcare Industry - Over 28%
of global business and close to 50% of USA business
• A proven Healthcare testing practice with
over a dozen current ICD-10 testing projects
8

9. ICD-10 Impact Assessment starting point
Predicted Vs. Actual
9
Shared
ICD-10
Test Bed
Risk Based
ICD-9 PCS
Codes
Risk Based
ICD-9 CM
Codes
High
Volume
Claims
High
Dollar
Claims
Case Mix
Index
DRG Shifts

10. Survey Question #2:
Has your organization started ICD-10 Testing?
10
40%
35%
30%
25%
20%
15%
10%
5%
0%
My organization has
begun ICD-10 testing
Has only completed
the impact assessment
Planning completed,
but have not started
testing
Haven't started
38%
24%
11%
27%

11. 11
Solution Overview
Holistic End to
End testing
Golden Data Set
& managed test
data service
Test Automation
Accelerators
Claim Generator
Accelerator

12. • All entities in the healthcare technology workflow
are tested using this medical records (Clinical and
claims data) test data.
• Testing all internal integrations down to billing and
clinical DWH
• Testing of all external partner integrations including
payers, clearinghouses and HIEs
• Testing of: business process, operations, revenue
neutrality and performance
12
Solution Overview
Holistic End to
End testing
Golden
Dataset
Test
Automation
Accelerators
Claim
Generator
Accelerator

13. • Utilization of real medical records dual coded in
ICD-9 & ICD-10
• No coding or GEM tools used in this process
• Your Medical records are coded and verified
through peer review by key industry experts
• No conversion of claim data from ICD-9 to ICD-10
13
Solution Overview
Golden
Dataset
Holistic End to
End testing
Test
Automation
Accelerators
Claim
Generator
Accelerator

14. Holistic End to
End testing
• Utilizing automation to accelerate data entry and
testing of all relevant systems
• Utilizing automation accelerators to access and
verify data
• Enables better utilization of human capital for
investigating fewer potential issues
• Establish a test automation framework for the
future
14
Solution Overview Test
Automation
Accelerator
Golden
Dataset
Claim
Generator
Accelerator

15. 15
Solution Overview Claim
Generator
Accelerator
Holistic End to
End testing
Test
Automation
Accelerator
Golden
Dataset
• Utilizing Claim Generator Accelerator to enable
direct creation of claim records for
standaloneindependent revenue impact testing
• Generates EDI X12 837 5010, UB-04, UB-100…
• Enable parallel internal and external testing
• Establish a test framework for the future

16. Survey Question #3:
What will be the source of your
ICD-10 test data?
16
40%
35%
30%
25%
20%
15%
10%
5%
0%
We will code our own
ICD-10 test data records
We will use a cross-walk
mapping tool to convert
ICD-9
We will use 3rd party
dual-coded service
Don’t know
38%
25%
8%
29%

17. Survey Question #3: Results from May 2013
17

18. 18
Converted Data
Vs.
Internally coded test data
Vs.
Golden Data Set

19. Dual Coded Clinical and Claims Data
The Golden Data Set is:
• Purpose generated by dedicated medical coders
• Dual coded in ICD-9 and ICD-10
• Includes:
19
o Demographic information
o Diagnosis and procedure codes (ICD-9 and ICD-10)
o Consult notes, discharged summary
o 5010 Claims
• Peer reviewed by:
o At least one more independent medical coder
• Beneficial to related ICD-10 remediation activities
o Training
o Risk management
o CDI Documentation and process updates

20. Survey Question #4:
How does your organization plan to enter your
ICD-9 and ICD-10 test data into your health
information systems?
20
40%
35%
30%
25%
20%
15%
10%
5%
0%
Manually In an automated
fashion with the use
of accelerators
Both Don’t know
40%
12%
21%
28%

21. Data Entry and Test Accelerators
Utilizing test automation accelerators to
rapidly enter and verify data
• Expedites test data entry
• Eliminates human error
• Enables low involvement of business users
• Increases test coverage
• The only method to enable real end-to end-testing
21
at a reasonable cost
• The 1st step in automating tests for long
term efficiencies

22. Data Entry and Test Accelerators
Clinical History and
Medical Coding
HIM
History and Physical
DATE OF ADMISSION: 02/12/2011
CHIEF COMPLAINT: Chest pain.
HISTORY OF PRESENT ILLNESS: The
patient is an 81-year-old gentleman
with past medical history of coronary
artery disease status post three-vessel
bypass surgery in the 1990s with a total
of 8 stents subsequently. He also has a
history of diabetes, hypertension,
dyslipidemia. He has chronic stable
angina managed with nitroglycerin
patches and Ranexa. Last night he
developed increasing chest pain and
had recurrent rest pain this morning.
Some mild diaphoresis. Denies
orthopnea, paroxysmal nocturnal
dyspnea or edema.
PAST MEDICAL HISTORY: As above.
MEDICATIONS:
1. Aldactone 25 mg daily.
2. Aspirin 325 mg per day.
3. Imdur 40 mg t.i.d.
Data Entry
Accelerators
Manually
Providers
Admin/Fin
Apps
REG
ADT
HIM
SCH
MPI
Bill/AR
Clinical Apps
Pt. Care
OE
Lab
OR
Rx
RAD
Results
EMR
CARD
Diet
Therapies
Comparison
Accelerators
Manually
Actual 5010
Claim
ISA*00* *00*
*ZZ*QUALITEST**ZZ*LQUALITES
TQAGROUPTEST*130405*0801*^
*00501*013752785*1*T*>~
GS*HC*QUALITEST*940360524*
20130405*080132*13755551*X*
005010X223A2~
ST*837*000000043*005010X223
A2~
BHT*0019*00*000000039*2013
0405*080142*CH~
NM1*41*2*TEST*****46*TEST~
PER*IC*CHS*TE*8043273100*E
M*TEST@TEST.COM*FX*8043235
848~
NM1*40*2*PAYER*****46*1122
334455~
HL*1**20*1~
PRV*BI*PXC*282N00000X~
NM1*85*2*MEMORIAL
MEDICAL*****XX*1111111112~
N3*1 MAIN ST~
N4*TORRANCE*CA*905055002~
REF*EI*951644042~
PER*IC*MEMORIAL
MEDICAL*TE*5551212151~
HL*2*1*22*1~
Expected
5010 Claim
ISA*00* *00*
*ZZ*QUALITEST**ZZ*QUA
LITESTQAGROUPTEST*130
405*0801*^*00501*0137
52785*1*T*>~
GS*HC*QUALITESTQAGRO
UP*940360524*20130405*
080132*13755551*X*0050
10X223A2~
ST*837*000000043*00501
0X223A2~
BHT*0019*00*000000039*
20130405*080142*CH~
NM1*41*2*TEST*****46*
TEST~
PER*IC*CHS*TE*80432731
00*EM*TEST@TEST.COM*F
X*8043235848~
NM1*40*2*PAYER*****46
*1122334455~
HL*1**20*1~
PRV*BI*PXC*282N00000X
~
NM1*85*2*MEMORIAL
MEDICAL*****XX*111111
1112~

23. Automation Accelerators Demo
23
Demo

24. When do you expect all of your major systems
to be upgraded and ready for ICD-10 testing?
24
Survey Question #5:
35%
30%
25%
20%
15%
10%
5%
0%
By the end of 2013 By the end of March
2014
After April 1st 2014 Don't know
14%
34%
29%
23%

25. Claim Generator Accelerators
25
Utilizing test automation accelerators to rapidly
generate claim records to enable stand alone
external revenue impact testing
Demo

26. Solution Benefits
• A high quality approach delivering maximum test coverage
• End to End internal and external business process testing
• Complete testing: business process, operations, revenue
neutrality and performance
• Reduced testing effort and duration – use of accelerators and
fewer false negatives
• Enable standalone external revenue impact testing
• Golden Data Set is the only solution unless your test data is
available now. Added value to multiple remediation activities such
as training, risk management and process updates
• Can reduce ICD-10 testing costs by up to 70%
• Can be done as a turnkey fixed price engagement
26

27. What we recommend organizations
27
should ask themselves now?
• Do you have an impact assessment including
analytics?
• Can you generate the test data in time?
• Will your payer partners test with you?
• What is needed for your payer partners to
adjudicate your test claims?
• When will your internal systems be upgraded?
• Will your internal systems be tested in time to
support external testing or should external testing
be conducted in parallel (or even before) internal
testing?

28. 28

29. For more information
Contact Tom Parnon
1-(203)-202-2682 ext. 202
ICD10@qualitestgroup.com
Visit the QualiTest website:
www.QualiTestGroup.com
or look for QualiTest on: