INDUSTRY WATCH: January/February 2014

ICD-10: More Testing Needed, Says WEDI

In its private-sector advisory role to HHS under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Workgroup for Electronic Data Interchange (WEDI) sent a letter to HHS Secretary Kathleen Sebelius suggesting that more robust Medicare testing is needed before the crossover from ICD-9 to ICD-10 codes on Oct. 1, 2014. 

The letter pointed out that implementation of ICD-10 and the ICD-10 Procedure Coding System will be much more complex than when the industry converted to the HIPAA-required Version 5010 of X12N and other HIPAA mandates, since the use of diagnosis and procedure codes impacts nearly every application and business process in hospitals, physician offices, and health plans, as well as vendor applications and clearinghouse functions. 

WEDI voiced concern that front-end testing alone would not appear to validate processes such as crossover or Medicare secondary claims, nor will it assist providers in determining the impact of ICD-10 on reimbursement. Rather, end-to-end testing is necessary to ensure that when the individual parts are put together, the system works as expected.