December 13, 2013

Recorded Webinar: Reducing Risk and Improving Visibility in Health Care Regulatory Testing

Helix ALM
Thanks to everyone who participated in the “Reducing Risk and Improving Visibility in Health Care Regulatory Testing” webinar.  The webinar recording is now available if you weren’t able to attend or if you would like to watch it again. Transcript from the webinar Q & A follows. During this recorded webinar, Mark Lott of the Lott QA Group and Jeff Amfahr of Seapine Software:
  • Explain how to more effectively test new and upgraded systems and gain better insight into revenue risk
  • Discuss the key objectives for any successful testing initiative
  • Outline the reports and metrics your team should focus on
  • Demonstration tools that can make testing more effective and efficient

Questions & Answers

What is the cycle time to get up and running for a Medicare medical clearinghouse and payer?

Mark Lott: It normally takes about 30-60 days to get up and running with the National Testing Platform because NDAs, BAAs, and other legal documents need to be signed. Then we do the analytics like I showed you and find out which charts we have to pull, communicate to trading partners, and go from there. Jeff Amfahr: On the Seapine TestTrack side it is a shorter time frame, maybe a few days at most, primarily focused on getting everything wired into your existing system, setting up the workflow and process that you need at that particular location. For example, there are often specific pieces of data a customer wants to capture along with setting up workflows, tracking estimated and actual time for work completion along with other data that typically takes no more than a few days to get setup and running.

You talked about the ability to test now. How can you enable that with a payer or clearinghouse?

Mark Lott: We do not need any system remediation done at a provider in order to test for the health plan. So what we did in our methodology is flip it—we don’t want the end-to-end testing to occur at the end we, want it to occur at the beginning. Why? Because you don’t want to be part of the group that is testing in August and September like a madhouse trying to figure out if you are going to be ok. To test with a health plan, all you need is a medical record and a previous claim. Re-code it and issue it back to the health plan, and then they can issue an 835. That is all you need and it will tell you if you are going to be ok or not. Then, run the test cases you gave to the health plan back though the front of the system, all the way through to the clearinghouse (like any normal test effort that you would do in a 5010 effort for example). If the 837 is compliant and matches the data sent to the payer four months ago, then you have completed your test.

What about transactions such as ASCX12?

Mark Lott: ASCX12 is the 5010 transaction—we do test those transactions. We test them for compliance and for clearinghouse compliance.

So the coder is a person and not a script?

Mark Lott: Yes, a coder is a physical person. The script is telling us what we are doing. The test script is going to say that we are going to send this knee replacement surgery though these departments. We are going to want radiology, labs, pathology, along with what came in through ER. So that we know when there is a change in the requirements in the emergency department, there was a change in the pathology department and so when we pull those records in we make sure that they actually have feeds from those departments. And we can see that those are now supposed to work with different value or larger field, to handle new codes.

What is communicated to the National Testing Platform from a clearinghouse?

Mark Lott: When the clearinghouse creates the 837, they send us a claim that they created and we can compare it to the other 837 we already did. This helps us determine whether that clearinghouse has made a good transactions on the behalf of that provider or if there are issues with that provider.