ICD-10 Testing: A Guide for Medical Practices

Healthcare organizations have raised many concerns about the transition to ICD-10, which will introduce thousands of new diagnosis codes, citing that a lack of preparation could result in an increase in claim denials. The compliance date, however, is still set for October 1, 2015, and it is unlikely that the deadline will be pushed back yet again. In order to avoid cash flow disruption resulting from claim delays and denials, medical practices must be proactive and take steps to prepare for the compliance date.

ICD-10 testing is by far the most important thing that practices can do to get ready for the switch in code sets. It is not required but will make a huge difference in determining how quickly providers get paid, particularly in situations where the wrong diagnosis code could result in a denial and extra work for billing staff.

Getting Ready for ICD-10 Testing

When it comes to ICD-10 testing, the first step for practices is to contact their software vendors to ensure compliance. Come October 1st, ICD-10-ready practice management software and electronic health record software will be necessary for processing clean claims. Using software that is ready for ICD-10 will also ensure that physicians are able to meet the new standards without any complications or disruption to workflow. 1st Providers Choice’s software solutions are ICD-10-compliant, and we are currently helping healthcare organizations carry out testing.

Providers will also need to coordinate testing efforts with the payers with whom they regularly work. Note that it is not necessary to test with each payer. Practices may choose to focus only on the ones that process the highest volume of claims. To find out how a particular payer is supporting ICD-10 testing, visit their website or contact them directly. Medical practices that use a billing service will need to contact the billing service to find out how they are handling the testing process.

The Centers for Medicare and Medicaid Services is offering two test cycles for ICD-10 testing. The first testing period will be from April 27 to May 1 for those who already registered. The next test cycle will take place from July 20 to July 24. Providers will need to contact their Medicare Administrative Contractor for details about signing up.

Creating Test Claims & Analyzing Results

When thinking about what to test, practices should keep it simple, focusing primarily on the most common diagnosis and procedure codes, as well as those that bring in the most revenue. This will prevent staff from feeling overwhelmed during the testing process. It is also important to throw one or two complex claims in the mix in order to avoid surprises.

Also, when creating test claims, remember to follow each payer’s instructions for doing so. Some may require a specific date to be entered or for specific data to be included in order to easily identify test claims.

Once test results are in, practices will need to check for ICD-10-related errors. If there are errors, staff should work with payers to understand what caused the errors and how they can be avoided. Once those issues are resolved, conduct further testing until all test claims processed are free from errors related to ICD-10.

To learn more about using our fully certified EHR software and ICD-10-compliant practice management system, contact us online or call 480-782-1116.