Embed Size (px)
DESCRIPTION
End-to-End Testing for ICD-10 June 18, 2013. Welcome. Presenters: Kari Gaare , Centers for Medicare & Medicaid Services Dean Cook , National Government Services, Inc. Topics. Why this project is needed What we set out to do What we have completed to date What we continue to do - PowerPoint PPT Presentation
Citation preview
End-to-End Testing for ICD-10June 18, 2013
Proprietary and Confidential
2
Welcome
Presenters: Kari Gaare, Centers for Medicare & Medicaid ServicesDean Cook, National Government Services, Inc.
Proprietary and Confidential
3
Topics Why this project is needed What we set out to do What we have completed to date What we continue to do
– Checklists (High Level and Detailed)– Collaboration (ICPs, Listening Sessions)– Other collaboration (CMS, HIMSS, NGS, WEDI)
More information Questions
Proprietary and Confidential
4
Why this project is needed
Proprietary and Confidential
5
Why this project is needed Past implementation challenges Upcoming regulatory requirements
– Need for further clarification of terms in ACA
January 1, 2014 Compliance date for EFT/ERA standard and operating rules
October 1, 2014 Compliance date for ICD-10
December 31, 2013 and December 31, 2015 Health plans certify compliance
November 7, 2016 Compliance date for Health Plan Identifier (HPID)
Proprietary and Confidential
6
End-to-end (E2E) testing process
Regulatory requirement
Implementation
End-to-end (E2E) testing • Level 1 testing • Level 2 testing • Level 3 testing
Transition to production Compliance date
Successful implementation
Proprietary and Confidential
8
Goals
To develop and implement a process and methodology for end-to-end testing of the transaction standards, operating rules, code sets, identifiers, and other Administrative Simplification requirements based on industry feedback and participation.
To develop an industry-wide “Best Practice” for end-to-end testing that lays the ground work for a more efficient and less time consuming method for health care industry testing of future standards, leading to more rapid adoption of the future standards.
Proprietary and Confidential
9
Intended outcomes Documents for all industry segments outlining the critical
checkpoints needed to ensure compliance. Checklist drafts are published and available and continue to be refined and published.
Universal testing process and methodology that can be adopted by all industry segments
─ Included in the checklists that continue to be refined and published.
─ Variation may occur depending on the requirement
Framework with definitions for end-to-end testing process, readiness, and compliance. Complete and published.
Proprietary and Confidential
10
What we have completed to date
Proprietary and Confidential
11
Pilot definitions approved Term Definition
End-to-end testing End-to-End testing is a focused process within a defined area, using new or revised applicable products, operating rules or transactions, throughout the entire business and/or clinical exchange cycle, for the purpose of measuring operational predictability and readiness. The End-to-End testing process should be performed in an environment which mirrors actual production as closely as possible, confirming the validation of performance metrics and analytics (reporting).
Readiness Readiness is a state of preparedness in which an Entity has completed verification and validation of applicable policies, procedures, guidelines, laws, regulations, and contractual arrangements with expected results. Additionally, entities will demonstrate readiness by completing internal documentation, establishing communication mechanisms and validation with external trading partners, training of appropriate personnel , scheduled deployments, and software migration for each regulatory requirements.
Compliance Demonstrated adherence to those policies, procedures, guidelines, laws, regulations to which the business process is subject in advance of, by or after the regulatory implementation date.
Proprietary and Confidential
12
Levels definedLevel Explanation of purpose
1 The period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level 1 compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges.
2 The period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. Key difference between Level 1 and Level 2: Level 2 is done in a “production-like” environment that may not be exactly a replicate of the production system.
3 The period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/production-like mode with the new versions of the standards by the end of that period. By ‘‘production/production-like mode”, we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. Key difference between Level 2 and Level 3: Level 3 is conducted in the same environment that is used when going “live” and into production.
Proprietary and Confidential
13
Levels and Elements assigned
Transition
Planning Assessment Design Development Testing Transition
Level 1 is the period during which entities perform all of their internal readiness activities in preparation for testing the new versions of the standards with their Trading Partners. When an entity has attained Level 1 compliance, it has completed all internal readiness activities and is fully prepared to initiate testing of the new versions in a test or production environment, pursuant to its standard protocols for testing and implementing new software or data exchanges.
Assessment Design Testing Transition
Level 2 is the period during which entities are preparing to reach full production readiness with Trading Partners. When an entity is in compliance with Level 2, it has completed some end-to-end testing with external Trading Partners. Key difference between Level 1 and Level 2: Level 2 is done in a “production-like” environment that may not be exactly a replicate of the production system.
Planning Testing
Level 3 is the period during which end-to-end testing is performed with external Trading Partners and the Trading Partner is able to operate in production/production-like mode with the new versions of the standards by the end of that period. By ‘‘production/production-like mode,’’ we mean that entities can successfully exchange (accept and/or send) standard transactions and, as appropriate, be able to process them successfully. Key difference between Level 2 and Level 3: Level 3 is conducted in the same environment that is used when going “live” and into production.
Proprietary and Confidential
16
Industry segmentsAt this time there are five industry segments being addressed in this project.
Small Provider Large Provider Payer Vendor-to-Payer Vendor-to-Provider
These industry segment checklists are all in continuous development and revision.
Proprietary and Confidential
17
High level documentsThe High Level End-to-End Testing Documents provide more of an overview than the “detailed” checklists.
There are two high level documents created for each industry segment (ICD-10 and Administrative Simplification).
Each High Level End-to-End Testing Document includes a Process Flow chart as a visual aid for the user.
These documents are available from the CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html.
Proprietary and Confidential
18
High Level ICD-10 End-to-End Testing Documents
Proprietary and Confidential
19
Detailed checklistsThe “detailed” checklists are Excel workbooks. Each identified industry segment has a detailed checklist.
Within the detailed checklists there are tabs for each of the following: Instructions Definitions Initial Assessment checklist Administrative Simplification checklist ICD-10 checklist Testing Guidance checklistThese checklists are available from the CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html.
Proprietary and Confidential
20
Large Provider
Payer
Small Provider
Vendor-to-Payer
Vendor-to-Provider
ICD-10 End-to-End Testing ChecklistsMicrosoft Excel
Worksheet
Microsoft Excel Worksheet
Microsoft Excel Worksheet
Microsoft Excel Worksheet
Microsoft Excel Worksheet
Proprietary and Confidential
21
Collaboration(Industry input, outreach, and participation)
Proprietary and Confidential
22
Industry Collaborative Partners (ICPs) Aetna* American Health Insurance Plans (AHIP)* American Hospital Association (AHA) American Medical Association (AMA) CMS Medicaid CMS Medicare Fee For Service Emdeon Healthcare Billing & Management Association (HBMA) IVANS Medicaid – CSG Government Solutions Medical Group Management Association (MGMA) Nachimson Advisors, LLC Providence Health and Services TIBCO Foresight TRICARE UNC Health Care Walgreens WellPoint Veteran’s Affairs
* Count as one ICP.
Proprietary and Confidential
23
ICP Webinars Participation by invitation; there are 18 ICPs Weekly or semi-weekly webinars (Tuesdays and Thursdays) as
needed Review and input forum for the following:
– Checklists– Related materials– Q&A from mailbox, webinars, and other special presentations
# Sessions # ICPs Avg # registered Avg # attend % Reg vs. attend
31 17 17 11 67%
Proprietary and Confidential
24
Listening Sessions Weekly or semi-weekly webinars (Tuesdays and Thursdays); more
sessions and other days as needed to meet demand Open sessions; invitation requests via email to
[email protected] NGS presentations with Q&A session following All registered attendees receive a copy of the presentation and the
related checklists via email; the checklists are also available on the CMS End-to-End Testing web page
Listening Sessions are on a break until July 2013 to allow the team to incorporate feedback and suggestions
Upcoming sessions will be listed on the CMS End-to-End Testing web page.
Proprietary and Confidential
25
Listening Sessions
Listening Sessions # Sessions to date Total attendance Average attendance
Small Provider 14 963 69
Large Provider 12 1,128 94
Vendor 12 764 64
Payer 9 765 85
Special sessions 3 302 101
Total 50 3,922 78
Proprietary and Confidential
26
Other outreach Questions, comments, and requests via email (
NGS Surveys
– Round 1 – January 2013
– Round 2 – March 2013
NGS Listening Session Real Time Polls
– Began April 16, 2013
– Continue when Listening Sessions resume in July 2013
Proprietary and Confidential
27
Other collaborations(CMS, HIMSS, NGS, WEDI)
Proprietary and Confidential
28
CollaborationCMS/NGS and HIMSS/WEDI collaboration CMS materials will be included in HIMSS/WEDI ICD-10 National
Pilot Program
HIMSS/WEDI participants will review and provide feedback on the checklists
CMS/NGS will review the products and results of the pilot program
Proprietary and Confidential
29
Differences
CMS/NGS and HIMSS/WEDI processes CMS/NGS is developing definitions and a description and
framework of end-to-end testing for all Administrative Simplification requirements, including ICD-10
HIMSS/WEDI is an actual application of testing specific to ICD-10
– Pilot sandbox to play in to test process
Proprietary and Confidential
30
CMS End-to-End Testing Pilot
What it does NOT include. A software package or application that will create test claims for the
industry
Test data to be used by the industry
A testing environment or universal testing platform
Proprietary and Confidential
31
CMS/NGS timelineNGS Pilot for End-to-End Testing Phase I – Business and Gap Analysis - September 24, 2012 through
December 21, 2012 (Complete) Phase II - Development of Pilot Testing (Artifacts, Definitions, Process and
Methodology) - December 10, 2012 through June 27, 2013 (approximately six months)*
Phase III - Implementation and Quality Assurance is July 1, 2013, and will run through September 23, 2013 (approximately three months)*
HIMSS ICD-10 National Pilot Program Early Phase – April 2013 through July 2013 Second or Middle Phase – August 2013 through December 2013 Third or Late Adopter Phase – January 2014 through June 2014
Proprietary and Confidential
34
CMS ICD-10 web page located at http://www.cms.gov/Medicare/Coding/ICD10/
CMS End-to-End Testing web page located at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/Affordable-Care-Act/End-to-End-Testing.html has links to all the checklists.
CMS Email Updates (CMS ListServ) feature is availableon all CMS web pages. Submitting your email addressensures notification of CMS updates including End-to-EndTesting checklists and other related documents.
Medscape Education modules link is available from the CMS ICD-10 web page (https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZS5vcmcvdmlld2FydGljbGUvNzY1NzU0&ac=401). Note that “Continuing medical education (CME) credits are available to physicians who complete the modules, but anyone can take them and receive a certificate of completion.”
Proprietary and Confidential
35
Contact information All questions may be sent to [email protected]
– Our expected level of service is to respond within one business day
Additional contact resources . . .
Resource Role Email addresses Work phone Cell phone
David Carrier Lead BA [email protected] (207) 253-1203 (207) 210-2340
Dean Cook Advisor/SME [email protected] (502) 889-4762 (502) 376-6510
Julie McBee BA/POE [email protected] (317) 595-4908 (317) 586-0021
