Creating ICD-10 Test Data
The Foundation for Accurate and Efficient Testing
The foundation for a successful approach to ICD-10 testing is having the right test data and scenarios to reflect each organization’s expected claim patterns in ICD-10. The scope of such an effort is enormous, and healthcare entities will need to prioritize their efforts, based on risk.
Edifecs ICD-10 Testing is part of an integrated suite of products, designed to help healthcare organizations to better create and manage ICD-10 test data, implement a risk-based approach to ICD-10 testing, and easily analyze and compare test results. Edifecs ICD-10 Testing relies on the capabilities of Edifecs Test Management, Edifecs Impact Analytics and Edifecs Code Management to simplify ICD-10 testing into a three-step process:
1. Reduce or filter down, all possible ICD-9 test data to justthe files that represent risk in the migration to ICD-10.There’s no point testing files where the mapping from ICD-9 to ICD-10 is straightforward. It’s wasted time and effort. Instead you should focus on the ICD-9 test files that could show up with many different ICD-10 codes after the migration.
Edifecs Impact Analytics analyzes your historical data to determine your high-risk ICD-9 code filters, which can be integrated directly into Edifecs Test Management for step two.
2.Convert your high-risk ICD-9 test data into ICD-10 equivalent test data. This can be done using the GEMs or can be done using your own custom maps. An organization may have a single map that covers all business processes or may have different maps for different functions, such as medical management vs. claim adjudication.
Edifecs ICD-10 Testing converts your ICD-9 test data to ICD-10 using either GEMS (forward, backward or consolidated), custom maps created using Edifecs Code Management, or maps developed in thirdparty applications.
3. Develop ICD-10 test files with sufficient variability to exercise processing systems. A single test file for each ICD-10 code will usually not provide the coverage needed to fully test processing. To get the optimum level of coverage, it will be necessary to create different versions of each claim, varied on dimensions such as provider, member or network participation.
Edifecs Test Management automates the process of creating different versions of test files,based on many levels of attributes including providers, members, network, date of service, etc.
Edifecs ICD-10 Testing integrates the analysis from Impact Analytics with the maps developed in Edifecs Code Management to automate the process of creating test data using a stratified, risk based approach. Once created, Edifecs Test Management provides a single repository so the test data that can leveraged test teams across the organization.
The ICD-10 Testing challenge is formidable, but not insurmountable. Using the right testing tools,healthcare entities can be sure they have a comprehensive approach that won’t break the bank, slip the schedule, or require an army of testers.