ICD-10 Testing: Testing Your EHR, Practice Management System and Internal Processes for ICD-10 Readiness

Transcription

1 : Testing Your EHR, Practice Management System and Internal Processes for ICD-10 Readiness Learning Objectives: Understand testing variables and procedures for addressing applications that store and use ICD content as part of their database and/or workflow. Understand testing variables and procedures for interfaced or external exchange of information with clearinghouses and payers. Planning a cutover process. How to remediate paper tools and clinical note specificity. How to mitigate lost productivity and external processes affected by ICD-10. Author/Presenter: John P. Glatthorn ICD-10 Program Management Consultant, CHOP - During the Previous Webinar - During part 1 of 3 the following topics were discussed: ICD-10 regulatory environment Defining the ICD-10 transition ICD-9 vs. ICD-10 coding and code characteristics How ICD-10 can affect your practice operations Guidelines for creating an action plan Avoiding risky coding practices Today is part 2 of a 3 part series 1

2 - Disclosures - This presentation contains some information technology jargon that will be defined at each step we appreciate your patience. If you have an in-house or external technology support representative that addresses system configuration, troubleshooting or testing, sharing this information is advised. The proceeding information addresses both large and small practices, some information may not pertain to your operations. Some practices do not have one system that performs all functions (such as an electronic health record and a separate billing application). The testing topics contain herein can pertain to any or all of your information technology applications. Consult your support resources for applicability. - Technology Testing: Code Database - Does your system contain a database of ICD-9/ICD-10 codes? Is this a full list or a partial list? o If partial, does this need to be translated to ICD-10? Is this provided by you (from the Medicare website) or is it provided by the software vendor? Who actually loads it? How often is it updated/loaded? (Oct 1 of each year new codes start being used. They are typically released days before) Prep: Translate any partial code sets to ICD-10 Prep: Understand the steps for code set import Prep: Understand the maintenance schedule for code updates Test: Loading ICD-10 codes into the system s database 2

3 - Technology Testing: Workflow - Where does the application allow you to enter/use codes? Are coding fields entered free-form or do they have a format? Do you need an indicator for ICD-9 vs. ICD-10 entries? Are pull downs populated properly? Are ICD-10 code descriptions truncated? What is the effect on problem lists in an EHR? What is the effect on orders in an EHR? Test: Clinical encounter/visit diagnosis entry and code choice Test: Biller charge entry Test: ICD-10 code and description display Test: Effects on the problem list in an EHR Test: Effects on orders in an EHR - Technology Testing: Mapping Capability - Does your system have a crosswalk from ICD-9 to ICD-10? Is one present? Is it accurate and does it suit your needs? Is it permanent or is it used only for a fixed period as users adjust to ICD-10 codes and nomenclature? What is required to turn it on? Do you want it on? Prep: Understand if your product offers a crosswalk Prep: Understand if it meets you needs Prep: Turn it on Test: Use the crosswalk in mock scenarios and determine if clinical accuracy or billing integrity is compromised by the choices available 3

4 - Technology Testing: Interfaces - Does your system have interfaces to/from other systems? Typically in HL7 (a healthcare messaging protocol) Is it getting an Admit, Discharge, Transfer feed? Is it sending Orders to diagnostic software or devices? Is it sending Charges between systems? Have all source and destination systems been verified as ICD-10 capable and is a coordinated cutover necessary? Prep: Verify if interfaces are present. Prep: Verify all source and destination systems are ICD-10 capable Test: Test all interfaces using mock messages, preferably in a test environment Test: Verify that order diagnoses used on charges with dates of service on of after 10/1/2015 are coded in ICD-10 - Technology Testing: Charge Rules and Edits - Does your system have charging rules or claim edits? Are they using diagnosis as a rule/edit criteria? Do you wish to implement edits that stop unspecified laterality codes from being billed? Do you wish to implement edits that prevent laterality CPT modifiers that conflict with diagnosis laterality? Prep: Identify affected rules or edits based on diagnosis Prep: Translate those rules/edits to ICD-10 and modify the rules Prep: Identify prohibited code lists / combinations and implement new rules/edits Test: Create mock charges using ICD-10 codes that violate those edited/new rules to assure they are functioning properly 4

5 - Technology Testing: Claim File Generation - Electronic billing files (837 claim, 835 remittance, etc.) These are text files, you can look inside them just change the suffix to.txt. The 5010 change in 2012 made claim files ICD-10 compliant. Testing focuses on the ability to generate claim files containing the correct indicators and codes based on date of service. Test: Generate a batch of claims that contain dates of service before and after the transition date ICD-9 and ICD-10 codes should never appear in the same electronic control number but can appear in the same physical file Test: If allowed, submit those test files to your clearinghouse or claims intermediary to determine their readiness for the transition - Technology Testing: Cutover Process - What is the process for the cutover to ICD-10 on or near 10/1/2015? Do you need to change system settings or set active dates? Do you need to split claims that span the transition date? Who performs these actions and when? Prep: Identify a point person for the cutover itself Prep: Understand if claim splitting is necessary based on your practice operations and dates of service Prep: Identify the cutover actions in the system to change the preferred code set from ICD-9 to ICD-10 Test: Perform a tabletop order of operations transition Test: Perform a mock system transition to determine issues 5

6 - Technology Testing: Reporting - Are you using diagnoses in report queries or as reportable fields? Are those queries using explicit ICD-9 codes do they need to be translated to ICD-10 and the query rewritten? Do ICD-10 codes fit in the same field lengths on reports? Do ICD-10 descriptions fit in the same field lengths on reports? Prep: Identify mission critical reporting needs Prep: Translate explicit ICD-9 codes for use in new queries Prep: Modify/reformat report fields that are not long enough to accommodate ICD-10 codes or descriptions Prep: Modify report queries to search ICD-9 and ICD-10 criteria Test: Run reports using sample ICD-10 transactions - Process Impacts: Provider Productivity - Provider documentation and code choice may slow down. Diagnosis specificity, even when aided by a decision tree or crosswalk, can shave seconds off each encounter. Note specificity can mean longer keyboard time or dictation time. Unfamiliarity with code set options and variations can be confusing or lead to excess unspecified code usage. Paper superbills / charge tickets / fee slips require alteration. A one page billing form may not be practical after ICD-9 codes are translated to ICD-10. Consider using a reference list of common diagnosis codes with a write in on the superbill itself rather than Dx and CPT on one. 6

7 - Process Impacts: Coder Productivity - Coding and abstraction in ICD-10 will almost certainly slow down. Attend training for ICD-10 coding and take advantage of medical societies and industry trade groups for fee based and free tools. Coders should practice abstraction using de-identified patient records from your highest volume encounters/procedures. Work with physicians to provide feedback and perform enhancement (if necessary) to the documentation s specificity so that questions, clarifications and unspecified code usage is minimized. Set new coding/abstraction productivity goals. Adjust productivity expectations to ramp up toward goals. - Process Impacts: Scripts and Insurance Referrals - Scripts to external providers Avoid word based diagnoses. Most front desk staff will not have discretion over translating words to the appropriate ICD-10 code. When possible, write both ICD-9 and ICD-10 codes on scripts within 1 month of 10/1 to avoid conflicts between issue date and DoS. Avoid unspecified laterality codes. Insurance referrals Understand the transition process outlined by insurance referral systems and payers as to when ICD-10 codes should be entered. Determine if a test system or sandbox environment is available to mimic a post 10/1/2015 environment and use it for mock insurance referral testing. Educate staff and clinicians on what ICD codes to use and when. 7

8 - Process Impacts: Pre-Certification - Insurance carriers are releasing formal pre-cert procedures starting Spring 2015 through Summer. Independence Blue Cross has said that starting 9/1/2015, it will require ICD-10 codes to be used on authorizations for dates of service on of after 10/1/2015. o Although this is not early usage for claims or adjudication, this does constitute pre-october usage for authorization. Look in provider newsletters (often having an ICD-10 section) and payer ICD-10 portals. Pre-cert usage of ICD-10 is not required to be uniform across all payers. o Create a grid or chart for authorization professionals to clarify payer specific rules and active dates. - Summary - Test the loading of a partial or full ICD-10 code set into affected systems. Test workflow and display properties including cross walking capability. Test internal and external interfaces with ICD-10 data. Test and create any ICD dependent edits and implement new ones. Test claim file generation and trading partner acceptance/edits. Outline a cutover process for Oct 1. Remediate reports dependent on ICD-9 codes. Mitigate productivity issues such as paper fee slips and note specificity. Mitigate productivity issues such as higher coding and abstraction time. Mitigate productivity issues such as changes in electronic insurance referral procedures and paper scripts to referred providers. Mitigate pre-certification issues such as active dates for ICD-10 code usage. 8

9 Future webinars will focus on: - What s next? - September 2 nd, :00am 12:00pm 7:00pm Final Preparations: Transition Date Activities and Interacting with Third Party Health Systems For copies of these slides in PDF format within 2-3 days, please go to: If you are having difficulty please DL-ICD10@ .chop.edu 9