Testing Your ICD-10 Claims Submissions: 8 Critical Questions

There certainly is a lot of buzz around testing in the healthcare industry. This buzz is definitely merited as we approach the ICD-10 implementation date on Oct. 1, 2014. Many hospitals and payers have indicated they are ready for this huge transition, but on the provider side this readiness is not as apparent, especially for small and medium providers.

A huge piece of ICD-10 implementation is to make sure your practice can transmit claims in ICD-10 and have the payer accept and pay them. If your practice cannot submit claims successfully, you will definitely notice a dent in your revenue stream after October.  

Testing requires careful planning. Resultant test data will help to identify interface system issues, a need for additional coding education, and any billing issues to be resolved prior to go-live.

 Consider the following questions when preparing for testing:

• What software requires updates or needs to be replaced in order to accommodate ICD-10 codes?

• If you have already made these upgrades, is it available for testing internally?

• Have you worked with your vendor and IT staff to set up a test environment that mimics the production environment?

• Do you have accurate data to test with? Code a few claims in ICD-10 and verify the coding is accurate. Will you be able to tell if the claim was denied because of interface issues or because of an incomplete code? What claims do you want to test? Think about the type of claims you submit most often and also consider those claims that cause current issues using ICD-9 even if they aren’t your highest volume.

• Have you performed internal testing to verify you can submit a claim in ICD-10? 

• Do you know what payers and clearinghouses you need to test with externally?

• Have you checked payer websites for information about their ICD-10 testing initiatives?

• Will you be able to test with all your payers or only a select few? If you can’t test with all the payers, do you have any peers that are planning to test with those payers/clearinghouses and are willing to share some of the results?

CMS recently announced that they will perform end-to-end testing of claims with ICD-10 codes this summer for a small sample group of providers. This testing will include submission of test claims and the provider’s receipt of a remittance advice. CMS’ testing will include a variety of provider types, claims types, and submitter types. For more information, see CMS' MLN Matters.

There is a lot to consider as you prepare for implementation and a wealth of information is available. You can learn more through Health Information Management Systems Society and the National Testing Platform regarding testing initiatives. CMS provides a variety of checklists, timelines, and implementation guides as well.  Also be sure to check out AHIMA’s resources for ICD-10 implementation.

So, is your practice buzzing (or even making a hum) about its internal and external testing plans?

Theresa Rihanek, MHA, RHIA, CCS, is a Director of HIM Professional Practice at AHIMA.

©2014 American Health Information Management Association (AHIMA). Reprinted by permission.