Nash Health Care's Ken Kilmer: Use ICD-10 testing to avoid chaos

For Ken Kilmer, ICD-10 project manager at Rocky Mount, North Carolina-based Nash Health Care System, conducting a weeklong mock ICD-10 transition earlier this month was all about avoiding chaos in 2015.

"The goal for this plan was to make sure that we knew what to do the night of activation, so that even if in the next year we had some staff turnover and there were some new people coming in that needed to do these tasks, we had enough detail in our plan that they would know how to execute the work that needs to be done," Kilmer told FierceHealthIT. "It was a real opportunity for us to make sure we don't have a lot of discord when we make that transition for real a year from now."

Kilmer, in an exclusive interview, shared lessons learned from the process, and also compared the mock transition to acknowledgement testing with the Centers for Medicare & Medicaid Services.

FierceHealthIT: Describe the mock transition. Was it what you expected?

Ken Kilmer: We thought the process to convert all of our systems and go through the activation would be easier because we had done it several times in the past. For example, we participated in the CMS acknowledgement testing, and we'd done some end-to-end testing with payers. We had remediated and converted parts of the system in the past, but this was our first real test of the entire comprehensive process.

That process turned out to be more difficult than we expected. We just thought that based on prior experience that we really knew what we were doing and we found that there were several areas where we just didn't have good, precise documentation or a knowledge of how to complete the steps.

FHIT: How did this testing compare to the CMS testing?

Kilmer: One of our biggest concerns is making sure we are able to produce claims that can go out to the payer and that that payer will be able to receive the claim. I think the CMS testing really validated that we were on track; we had tested our systems internally, but we had never really tried to start from the beginning and go all the way through to the end and get a claim out the door.

Each time we go through new testing, we find out a little piece that we maybe hadn't identified before that we need better documentation for. As we went through this latest testing, we found a lot of opportunities to add detail to the plan. There were steps that we thought we knew how to execute that we really didn't know how to complete. We were able to get those steps documented and get the detail into the plan so that the next time we go through this, if it's the same person they know what to do, and if it's a different person, they'll have enough detail to complete the work, as well.

FHIT: Will you conduct additional mock transitions leading up to October 2015?

Kilmer: I've been in the IT project management world for a long time and I know that when you go through an activation, you go through these activation testing stages and the first time there's a lot of chaos and it takes you a lot longer than you'd expect, and then you do it again and you have a lot less of that but you still have some of it. Maybe the third iteration you have even less.

I would not be surprised if, when we get to activation, we still have some a couple of things that we struggle with. We just need to make sure that we know the right steps, but we'll have tested at least two or three more times before that, so that the amount of unknown is negligible.

FHIT: Does the prospect of another delay concern you?

Kilmer: One of the biggest negatives from this most recent delay is that it creates a lot of uncertainty of whether any deadline is going to stick. That could diminish the commitment to moving forward. But it's so important for hospitals to move forward because all of this drives reimbursement. You just can't risk not getting paid for the services you provide. We, along with a majority of providers, I'd suspect, are moving forward as if that plan is set in stone.

Editor's Note: This interview has been condensed for clarity and content.

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