The Four Essential Steps in ICD-10 Testing

The consequences of failing to comply with the ICD-10 transition mandate will bring about serious consequences for healthcare organizations-both payers and providers. With the potential loss of revenue, efficiency and customer satisfaction arising from a backlog of suspended and unpaid claims, the importance of testing as the key means of assessing conversion readiness cannot be overstated.

In order to have a successful go-live and to be compliant with the ICD-10 requirements, each organization will have to navigate their way through these four essential steps:

1.     Test Planning: Understanding the scope and setting the precedence for each element in Unit Test and UAT (Unified Application Test).  Since there is a logical and step-by-step flow of business processes, from beginning to end, it follows that the test plan must mirror the business.

2.     Testing Protocol: How the tests for both logic and business process will be performed is the most critical step.  In advance, the test team must develop each step-by-step test case AND define each expected result. Test cases must be defined for conditions that will pass as well as those that will fail.

3.     Remediation: Prioritizing and remediating the unexpected errors identified during testing and, where necessary, adding test cases to the protocol.  Prior to completion of this step, all test cases must be re-run until the overall results conform to the test plan.

4.     Readiness Assessment and Turnover: Reviewing and documenting that the applications and business processes are deemed compliant with the test plan and thus ready to be turned over for production.

Because the amount of testing required is significant, many organizations will follow a process that tests the codes most necessary to an organization’s early success, e.g. enrollment. Once vital codes have been tested, the project team can move on to test code for more specific use cases.

IT professionals within healthcare organizations will be under a great deal of pressure to deliver an ICD-10 compliant environment. Test teams that can ensure providers receive payment on time will be extremely valuable assets to any organization as they will also be responsible for transferring knowledge to others.

Testing for the transition to ICD-10 and all of its ancillary parts may seem like the final step in the grand scheme of the transition but the value of planning for this phase early on should not be underestimated.

Truth #2
The only effective protocol for testing is to perform it until the results fully meet the criteria of the test plan.