End-to-End Testing for ICD-10 June 18, 2013

1. End-to-End Testing for ICD-10June 18, 2013

2. Welcome • Presenters:Kari Gaare, Centers for Medicare & Medicaid Services • Dean Cook, National Government Services, Inc.

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

4. Why this project is needed

5. Why this project is needed • Past implementation challenges • Upcoming regulatory requirements • Need for further clarification of terms in ACA

6. End-to-end (E2E) testing process Successful implementation

7. What we set out to do

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.

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.

10. What we have completed to date

11. Pilot definitions approved

12. Levels defined

13. 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. Levels and Elements assigned Planning Assessment Design Development 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. Assessment Design Testing Transition 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. Planning Testing Transition

14. What we continue to do

15. Checklists

16. Industry segments At 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.

17. High level documents The 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.

18. High Level ICD-10 End-to-End Testing Documents

19. Detailed checklists The “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 checklist These 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.

20. ICD-10 End-to-End Testing Checklists

21. Collaboration(Industry input, outreach, and participation)

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.

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

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 ngs.compliancetesting@wellpoint.com • 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.

25. Listening Sessions

26. Other outreach • Questions, comments, and requests via email (ngs.compliancetesting@wellpoint.com) • 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

27. Other collaborations(CMS, HIMSS, NGS, WEDI)

28. Collaboration CMS/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

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

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

31. CMS/NGS timeline • NGS 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  

32. CMS/NGS timeline

33. More information

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 moduleslink 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.”

35. Contact information • All questions may be sent to ngs.compliancetesting@wellpoint.com • Our expected level of service is to respond within one business day • Additional contact resources . . .

36. Questions?