Insights Blog Hospital Network Modernizes to ICD-10 Compliance and Migration

Case Study

Hospital Network Modernizes to ICD-10 Compliance and Migration

With a new compliance deadline to meet, how does one ensure that a hospital’s systems are up-to-date?

Scaled Agile

Client Overview

The client is a network of 15 U.S. hospitals that places special attention on servicing the needs of the lower classes and their local communities. Their hospitals service over 90,000 outpatients annually, with over 455,000 total visits, and have received numerous independent awards in their industry.

Business Needs

The client approached Qualitest for assistance in ICD-10 compliance and migration, a process which entails switching all internal and external medical coding from the outdated ICD-9 codes to an entirely new system. With 15 different hospitals and compliance required by October 2015, the major concern was ensuring a timely transition for their main internal systems, consisting primarily of 3M, GE Centricity, and MediTech.

The Qualitest Solution

Qualitest’s ICD-10 solution consists of 5 main facets:

  • Internal testing: Testing how the information flows within the provider system; this process ensures that ICD-10 codes are processed correctly from beginning to end
  • External testing: Testing how transactions are sent and received between external trading partners, such as payers, clearinghouses, billing services, etc. through channels already in use
  • Revenue impact testing: Testing ensures that the processing of data, either ICD-9 or 10, does not negatively impact revenue generation, and that there are no vast differences in the revenue generated between ICD-9 and ICD-10 data
  • End-to-end business process testing: Testing ensures that the full spectrum works together and meets the expectations of everyone involved (from doctors and patients to billing services and clearinghouses)
  • Clinical Documentation Improvement (CDI) testing and validation: Because ICD-10 can sometimes require more coding, this validates the appropriateness of, identifies deficiencies in, and recommends improvements to the new coding

Key Benefits:

  • These facets were addressed through the utilization of Qualitest’s Golden Data Set, a set of dual-coded medical records, and test automation accelerators.
  • The peer-reviewed data of the Golden Data Set eliminated the need for cross-walks or GEMs, which can be costly, slow and less effective than the Data Set.
  • With the test automation accelerators, Qualitest improved speed and accuracy of data entry without the need of human input, effectively adding speed and efficiency to the testing process and lowering the potential for human error.
  • By making use of these products, QualiTest was able to complete thorough testing of all necessary systems with plenty of time remaining until the October 2015 compliance deadline.