Once the organization's internal IT systems are fully ICD-10 upgraded or replaced and working as predicted and that clinicians are well-versed in any new documentation requirements, practice professionals can begin to initiate testing with external partners.
For many practices, the clearinghouse will be an important external testing partner. Communicate with your clearinghouse as soon as possible to determine if and how they will be testing claims and other transactions, and what ICD-10 services and resources they are offering.
Testing with health plans might prove to be more challenging. Medicare's recent announcement that it will not be testing with physician practices has added a new layer of uncertainty to the external testing process. Practice professionals will want to identify, at a minimum, the health plans that account for the majority of their reimbursements and determine if and when they will be testing ICD-10 claims. It is critical to identify health plans' ICD-10-specific payment policies with an emphasis on alterations to payment, acceptance of unspecified codes and new or revised documentation requirements.
Health plan testing should be conducted with two goals in mind: to determine whether the health plan will accept and pay the ICD-10 coded claim; and if the change to ICD-10 will affect reimbursement levels.
For physician practices, testing will be a critical component to a successful migration to ICD-10. Failure to fully test any one of these stages puts the organization at risk for catastrophic cash-flow disruption after the compliance date because of delayed or denied reimbursement.
To download a guide to preparing for the transition to ICD-10, visit the MGMA website.
Senior policy adviser MGMA