Post by Admin on Jan 20, 2014 16:04:19 GMT -5
Q. Why real medical records? What difference does it make if we use GEMS mapping or handmade scenarios?
A. In a real-time environment it's not enough to only test the correct ICD-10 coding responses. Testing should be reflective of what is experienced in the real world every day. ICD-10 is new to the entire healthcare industry, as such, there should be an expected learning curve whereby members of your organization will need to learn and apply the coding guidelines accurately. Coders viewing and coding real redacted patient files allows them to practice a new process in an environment that is already familiar to them.
Additional benefits:
A. In a real-time environment it's not enough to only test the correct ICD-10 coding responses. Testing should be reflective of what is experienced in the real world every day. ICD-10 is new to the entire healthcare industry, as such, there should be an expected learning curve whereby members of your organization will need to learn and apply the coding guidelines accurately. Coders viewing and coding real redacted patient files allows them to practice a new process in an environment that is already familiar to them.
Additional benefits:
- Dual coded medical records start with known ICD-10 codes to validate accuracy of medical billing companies; mapped or handmade scenarios do not test these functions
- Providers using dual coded medical records can test vendor readiness, coding accuracy tools, manual coding accuracy, provider contracts and trading partners; mapped or handmade scenarios do not test these functions
- For vendors, the patient encounter process is documented within the medical record and contains data necessary to test software and work flows; mapped or handmade scenarios do not test these functions
- Dual coded medical records and 5010 file formats are provided to the health plans to enable successful ICD-10 testing. The medical records can be traced through the entire process to verify complete end-to-end testing with all trading partners. Mapped or handmade scenarios may be used for internal testing & gauging some provider behaviors, but it is labor intensive in the review and the tests are not coordinated to generate real claims from the provider system.