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ICD-10 Integration. Are You Ready?

ICD-10 Integration. Are You Ready?

February 17, 2015
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The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is a revision of the ICD-9-CM system currently in place. The Affordable Care Act (ACA) is requesting that healthcare organizations adopt ICD-10 code set standards and operating rules soon, requiring documentation proving that healthcare organizations are compliant and that they have completed end-to-end testing with their partners.

Internal integration involves identifying and merging the individual processes of ICD-10 to seamlessly integrate it into existing processes. Optimize the flow of processes by identifying and adding/removing any steps for review and approval before validating the test region to make sure all of the required processes have been integrated correctly. After internal integration, internal end-to-end testing is performed to ensure that all of the processes and systems are moved to the test server. Making changes and testing those changes in the internal systems before testing new implementations with external partners, ensuring continuous delivery, will prove paramount in the migration from ICD-9 to ICD-10. The goal of internal integration is to validate that the entire system is functioning efficiently with no major issues and validating all internal/external reports by encouraging the end users to test, then validate, the ICD-10 data outputs. If ICD-10 implementation has properly integrated on the test server, then we’re ready to push code to the external servers for partner testing.

Testing on the external server should consist of both small and large clients with a wide array of different submission and data input-both manual and automated testing is beneficial here. It is important to establish the confidence that both historical transaction data and new incoming data will be passed successfully. High-volume procedures, diagnoses, DRGs, and payers should be first priority. If the payer organization implements a certification process for partners passing this phase of testing, then it will be easy to recognize the client’s ability to accept ICD-10 standards with the new implementation. Trading partner testing on external servers ensure that trading partner transactions are validated against the implementation guides. If you integrate a single clearinghouse to submit all of your claims then external testing will be greatly simplified while facilities that directly submit claims, including government claims, should test with every partner. Most of the time and effort for testing ICD-10 integration should be spent executing this phase since it’s one of the most important phases that will prove ICD-10 readiness.

The stages of ICD-10 implementation readiness will make or break the ability for you to engage with qualified partners and vendors who successfully implement it. One of the best practices successfully implemented by partners, is to involve multiple vendors responsible for each phase of testing. Payer-to-payer testing can validate future integration with large payers like Medicare and Medicaid and ensures that data received is properly transmitted to the payer receiving them. It will provide increased visibility and validation to the entire testing process. With healthcare as an evolving industry, web based applications provide the greatest flexibility toward future changes in HIPAA, as well as mergers or acquisitions among your healthcare customers.

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