Collaborative Testing. Ryan McDermitt, Senior Director of ICD-10 Product Management

Transcription

1 Collaborative Testing Ryan McDermitt, Senior Director of ICD-10 Product Management

2 Collaborative Testing Process Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Define testing program Scenario based testing approach Payer and provider exchange test data Payer executes tests and uploads results Payer and provider compare test data

3 Identification Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Identify high priority providers based on: Claim volume Billing dollars Mapping complexity MS-DRG shift Identify high-risk claim scenarios for each provider

4 Outreach Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Invite providers for collaborative testing: Automated communication Self-registration process Step-by-step testing program

5 Joint Test Planning Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Invite providers to collaborate on testing by: Share Testing Strategy and Test Plans Share High risk scenarios and Code list Invite providers to submit claims for respective scenarios

6 Test File Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Create and share test data 1. Payer identifies and share seed data 2. Payer shares test files 3. edits in biz view 4. submits ICD-10 test data Members s

7 Test Result Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications Claim ICD-9 ICD-10 Variance 1 $100 $80 -$20 2 $200 $180 -$20 3 $40 $80 +$40 4 $100 $80 -$20 5 $100 $80 -$20 6 $100 $80 -$20 7 $100 $80 -$20 Compare results using interaction reports: Allowed amount Payment amount Patient responsibility Coding review

8 Payer- Communications Collaborative Testing Process Identification Outreach Joint Test Planning Test File Test Execution Test Result Payer- Communications notification Reference library Issue management Progress tracking Surveys and questionnaires

9 Pilot for End-to-End Testing of Compliance with Administrative Simplification Vendor Checklists (Vendor-to-Payer) Presented by National Government Services, Inc. Julie McBee, Business Analyst/POE David Carrier, Lead Business Analyst/SME Dean Cook, Project Advisor/SME

10 Topics Vendor Audience Vendor Checklists Contact Information 2

11 Vendor Audience Vendors (Vendor-to-Payer) include organizations comprised of, but not limited to the following: Third-party billing services Clearinghouses Network services Practice management systems Value-added networks Software vendors 3

12 Vendor Checklist The Vendor (Vendor-to-Payer) Checklist information will be available in one document that contains the following: High Level Checklists one each for Administrative Simplification, Affordable Care Act (ACA), and ICD-10 Instructions Spreadsheet Checklists with tabs for General Information (one for each project tab) and one tab each for Administrative Simplification, Affordable Care Act, and ICD-10 4

13 Vendor High Level Checklist There is one high-level checklist for each of the three projects included in this pilot. The high-level checklists are industry segmentspecific. These are the Vendor-to-Payer high level checklists: Vendor-to-Payer Administrative Simplification End-to-End Testing Checklist Vendor-to-Payer Affordable Care Act End-to-End Testing Checklist Vendor-to-Payer ICD-10 End-to-End Testing Checklist These will be available from the CMS website following the WEDI conference. 5

14 Vendor Spreadsheet Checklist This is the spreadsheet checklist for Vendorto-Payer. There are similar spreadsheet checklists for each of the designated industry segments. There is a tab for each of the following: Instructions General Information (one for each project) Administrative Simplification Affordable Care Act ICD-10 These will be available from the CMS website following the WEDI conference. Eventually, all of the Vendor-to-Payer checklists will be available in one document. ngs.compliancetesting@wellpoint.com 6

15 Contact information All questions may be sent to Available 24:7 Our expected level of service is to acknowledge all s within 24 hours during normal business hours Additional contact resources... Resource Role Addresses Work Phone Cell Phone David Carrier BA II (207) (207) Dean Cook SME/Advisor (502) (502) Julie McBee BA II POE (317) (317)

16 USING CMS END-TO-END CHECKLISTS FOR HIMSS WEDI ICD-10 PILOT THE STRENGTH OF COLLABORATIVE TESTING HIMSS WEDI NATIONAL ICD-10 PILOT PROGRAM Mark A. Lott, CPHIT, CPHIMS CEO The Lott QA Group Co-Chair HIMSS WEDI Testing and Methodology Workgroup

17 PRESENTATION OVERVIEW HIMSS WEDI ICD-10 National Pilot Program Shared Test Data Approach for Testing Based on Real Medical Records Dual Coded and Peer Reviewed End-to-End Testing Asynchronously CMS-NGS End-to-End Checklist Checklist Usage During ICD-10 Pilot Questions and Answers Learn more at and

18 HIMSS WEDI ICD-10 PILOT HIMSS WEDI Co-Sponsorship AHA, AHIMA and CMS Cooperating Parties Multi-stakeholder End-to-End Testing Pilot Based on Dual Coded Medical Records Shared Test Data With All Participants Coding Accuracy and Proficiency (Manual & CAC) Claims and Remittance Testing Collaborative Testing Framework Testing Metrics and Lessons Learned

19 ICD-10 TESTING OPPORTUNITIES Business Driven Testing Approach Moves Away From Mocked Up Data to Real Data Testing More Closely Replicates Real World Frequency Distribution of Clinical Events Which ICD-10 Codes Require National Testing Superset of Test Cases Shared Nationally Located in the ICD-10 Playbook After Pilot Completed Coding Accuracy Analytics Greater Testing Involvement End-to-End Testing Too Expensive in a Silo

20 Vendor Testing

21 END-TO-END CHECKLIST FOR ICD-10 LEVEL 2: Testing period is the period during which covered entities are preparing to reach full production readiness with Trading partners. When a covered entity is in compliance with Level 2 it has completed end-to-end testing with Trading partners. 1 CMS CHECKLIST HIMSS WEDI USAGE Develop test plans and scenarios for all systems, interfaces, transactions, reports, For Phase 1 of the pilot - The Lott Collaborative Test Method is being used as the end-to-end data extracts affected by regulation change. testing methodology and the HIMSS ICD-10 Playbook houses the shared test data, medical Working with your Trading Partners determine testing schedule, required test scripts, and testing protocol, document; update Quality Assurance Plan (QAP) and test cases meeting the requirements of vendors for testing Determine if there are other Trading Partners that will require testing Determine if the entity you are testing with will require you to use the entity's test data records and dual-coding exercises The pilot manages and coordinates all the trading partner testing. The test scripts along with the entry and exit criteria for each pilot participants is provided through the testing methodology The pilot consists of voluntary early adopters that enable the entire transactional lifecycle for endto-end to be tested The testing process requires all entities to test using the same test data for complete traceability through HIM, PMS, CAC, Clearinghouses and Healthplans remediated systems.

22 Discussion