ICD-10 News: Testing Tips

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While ICD-10 is almost here, you still have time to get ready. But you must get ready now. Each day this week we are highlighting 1 of the 5 recommendations to help you begin testing: 1) Why Test Now, 2) How to Get Started, 3) Testing with Trading Partners, 4) Types of Testing, and 5) Testing Tips.

Today our focus is:

Type of Testing

Testing Tips

Getting the Most Out of Testing

To get the most out of testing for your practice, you should:

• Review testing requirements to understand the scope and format of the testing available
• Focus on your highest-risk scenarios, such as claims processing and the diagnoses you see most often
• Prioritize testing with health plans, concentrating those that account for the majority of your claims
• Avoid common billing errors, such as:
  • An invalid National Provider Identifier (NPI)
  • Invalid Health Care Procedure Coding System (HCPCS) codes on professional claims
  • Invalid postal ZIP codes on professional claims
• Test as often as you can

CMS Provider Testing Tools

CMS offers the following tools to assist with testing:

• National coverage determination (NCD) and local coverage determination (LCD) conversions from ICD-9 to ICD-10
• The ICD-10 Medical Severity Diagnosis-Related Groups (MS-DRGs) conversion project, which is available along with payment logic and software replicating the current MS-DRGs. Also on this webpage are the:
  • ICD-10-CM MS-DRG Grouper
  • Medicare Code Editor (available from the National Technical Information Service)
  • MS-DRG Definitions Manual, which allows you to analyze any payment impact from the conversion of the MS-DRGs from ICD-9 to ICD-10
• The 2015 versions of the Integrated Outpatient Code Editor, which include ICD-10

You Can Test – Even If Your System Is Not Ready

If you don’t have an ICD-10-ready system installed yet, you can still conduct meaningful testing. One good way to start is to look at the ICD-10 codes for the top 10 conditions you see. Consider volume of conditions and those that account for most of your revenue. Look at recent medical records for patients with these conditions and try coding them in ICD-10 for practice. Do the records include the documentation needed to select the correct ICD-10 code? You can use any cases of insufficient documentation to create a checklist for clinicians to consult.

To learn more about getting ready, visit cms.gov/ICD10 for free resources including the Road to 10 tool designed especially for small and rural practices, but useful for all health care professionals.

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website and Roadto10.org for the latest news and resources to help you prepare. Sign up for and CMS ICD-10 Industry Email Updates and follow us on Twitter.