Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare

40.3.5 – Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) (User) and the Single Testing Contractor (STC) Testing Requirements (Rev. 97, Issued: 01-15-16, Effective: 09-21-15, Implementation: 09-21-15) A/B, DME MACs are not mandated to prepare and execute test cases that cover Medicare business requirements implemented within the base system in standard system and CWF quarterly releases. Shared System Maintainers and the STC are fully responsible for testing the base functionality. The A/B, DME MAC (users) shall test their local/unique components and conduct a limited, end-to-end, operational test. 1. A/B, DME MACs shall fully test their local components and processing rules prior to production implementation of the quarterly release. This testing is applicable for all local components and processing rules modified since the previous quarterly release. A. A/B, DME MACs shall test any system components they maintain and implement to support claims processing in addition to the base system. This includes front-end and back-end components such as those for EDI entry and translation, EDI outbound processing, and printing (e.g., MSN generation). B. A/B, DME MACs shall test changes they make to user control files, facilities, and tables in order to implement new Medicare policy or business rules. Examples of these facilities include but are not limited to auto adjudication facilities (e.g., ECPS and MCS SCF) and the MCS SPITAB. C. A/B, DME MAC shall fully test any shared system functionality that was: - Developed by the shared system maintainer solely for them, or - Developed by the shared system maintainer under a special project in which they were the exclusive participant. An example would be a MAC working with CMS on a special demonstration project. In this example the MAC shall fully test the shared system functionality that was implemented for the demonstration project. 2. A/B, DME MACs shall complete a limited end-to-end operational test that incorporates the shared system release, integrated with their other claims processing components. These components include the front-end for claims receipt, translators, the CWF, the financials, and back-end EDI and report generation. The test must ensure that processing is contiguous from claims entry, to claims adjudication, and ultimately remittance and Medicare Summary Notice generation. Through contiguous processing, the interfaces between all key claims processing components must be exercised. The banking system interfaces such as National Clearing House (NCH) transfers need not be exercised. The test is limited in the number of test cases that are required, since shared system maintainers and the STC are testing the base functionality of the shared system. A. A/B, DME MACs shall ensure that the integrated systems software can complete cycles without system abends and produce the expected output. The A/B, DME Medicare Contractor shall ensure their operational test: • Exercises all claims entry points not fully incorporated in the base system such as paper and EMC front-end components; • Includes all allowable standard electronic formats and versions; • Includes a variety of claims types; and • Includes all components that support their claims workload and interfaces to the shared system. B. The operational test shall include the most recent shared system release received prior to the initiation of the test. A/B, DME MACs shall initiate the test as required to ensure its completion and the reporting of any problem prior to production implementation. 3. CMS strongly encourages the shared system user community to promote: • Standardizing their system nationally, • Centralizing any table maintenance that implements national Medicare policy at the system maintainer level, and • Minimizing local variations. 4. A/B, DME MACs may perform additional testing on the shared system or duplicate Beta testing tasks as time permits. At the discretion of their Regional Offices, the A/B, DME MACs may be required to separately document any testing they perform in addition to their mandated testing. 5. A/B, DME MACs shall test any business rule or event with future dates that they code or set- up in their Auto Adjudication Software (AAS), prior to implementing the rule or event into production. Examples of AAS include but are not limited to ECPS, SCF, the Shack, and the Mill. a. A/B MACS shall submit their date simulation recommendations to the FISS FWG in advance and participate in discussions at the FWG calls, as required to reach consensus on a date simulation schedule. b. A/B MACS shall submit their date simulation recommendations to the MCS FWG in advance and participate in discussions at the FWG calls, as required to reach consensus on a date simulation schedule. c. DME MACS shall submit their date simulation recommendations to the DMOP TAG or the CFMTAG in advance and participate in discussions at the TAG calls, as required to reach consensus on a date simulation schedule. d. The FISS FWG, MCS FWG, and DMOP/CFM TAG shall use the “system date request process” to provide the VDC(s) their latest “run-date simulation” schedule for their FISS, MCS, and VMS UAT environments. e. The FWG or DMOP TAG shall maintain their “run-date simulation” schedule for a minimum of 14 calendars days in advance. Here is an example of a “run-date simulation” schedule: Calendar Date System Run Date Calendar Date System Run Date Calendar Date System Run Date 10/8/2015 10/5/2015 10/17/2015 10/14/2015 10/26/2015 10/23/2015 10/9/2015 10/6/2015 10/18/2015 10/15/2015 10/27/2015 10/24/2015 10/10/2015 10/7/2015 10/19/2015 10/16/2015 10/28/2015 10/25/2015 10/11/2015 10/8/2015 10/20/2015 10/17/2015 10/29/2015 10/26/2015 10/12/2015 10/9/2015 10/21/2015 10/18/2015 10/30/2015 10/27/2015 10/13/2015 10/10/2015 10/22/2015 10/19/2015 10/31/2015 10/28/2015 10/14/2015 10/11/2015 10/23/2015 10/20/2015 10/1/2015 10/29/2015 10/15/2015 10/12/2015 10/24/2015 10/21/2015 10/2/2015 10/30/2015 10/16/2015 10/13/2015 10/25/2015 10/22/2015 10/3/2015 10/1/2015 f. The FISS FWG, MCS FWG, and DMOP/CFM TAG shall provide a copy of their “run-date simulation” schedule to their CWF test host. g. The FISS FWG and MCS FWG shall provide a copy of their “run-date simulation” schedule to the HIGLAS test site as required to accommodate their HIGLAS enabled contractors.