The Workgroup for Electronic Data Interchange has released a new whitepaper providing small physician practices with guidance for ICD-10 testing.
The Centers for Medicare and Medicaid Services defines a small physician/provider practice as having one to five physicians providing single or multi-specialty services
For many small provider organizations, the uncertainties surrounding the impending ICD-10 transition can be daunting. For this reason, [WEDIs] ICD-10 subworkgroup has structured the paper as an easy-to-follow instructional guide, addressing the who, what, where, when, why and how of the testing process, said Devin Jopp, president and CEO of WEDI, in a written statement.
According to WEDI, when it comes to determining what to test the focus for providers should be on those diagnoses that have the greatest probability in impacting how a claim is processed based on experience. In addition, the whitepaper recommends determining what to test then perform testing based on actual utilization and real claims. This is highly recommended, because this enables comparison between actual and test data, states the document. It also reduces the need for testers to have the extensive clinical/coding knowledge necessary to create test claims from scratch.
WEDI also advises ICD-10 testing with one or more payers to ensure claims are being adjudicated correctly. When to test will be somewhat driven by when the identified top payers are ready to test with you, notes the whitepaper. Consider testing windows but also your own resource availabilitythen give yourself enough time prior to the compliance date to complete testing. The closer you get to the compliance date, the more providers will want to test, potentially limiting payers ability to test.
In providing guidance to small practices, the whitepaper makes a couple of assumptions: providers internal systems are ready for ICD-10 and providers do not use a billing service. The paper notes that those who do use a billing service should account for that when using this information (i.e., coordinate as needed with a billing service in addition to or instead of working directly with payers and/or clearinghouses).
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