Icd10 organization strategy

ICD-10 Organizational Strategy February 18, 2010
Mike Arrigo
Managing Partner, CEO
No World Borders, Inc.
For more details, assessment info
icd10@noworldborders.com
(Please send from your payor or provider email domain address)
http://www.noworldborders.com/icd-10/

ICD-10 Topics
Organization readiness
Organization impacts
Process impacts

Most Payers & Providers Are Under Estimating the Joint Requirement & Analysis Time for 5010 and ICD-10
Establishing organizational structure
Planning to replace, upgrading claims system
Secure compliance attestation from clearing houses
Review process impacts and improve process
Developing scoping & requirements documents

ICD-10Organizational Impact

Understanding Stakeholder Impacts
Health Plan
Providers
Employers
Members
Vendors
Regulatory Agencies

Detail of all Business Functions & Systems.

Organizational Capabilities Checklist
Business & IT alignment
Business roadmap
IT portfolio management
Unique knowledge of impacted business areas

Claims Coding & Authorizations
Case Management Expertise
Experience with vendor chosen claims system
Experience with case management tools
Experience working with ICD-10 in other countries

Claims Adjudication
CMS view
Fraud analytics
ICD-10 Strategy
Data Warehouse

Business Intelligence
Regulatory expertise
Remediation areas checklist
Training
GEMS, Crosswalks
Vocabulary & nomenclature

Achieving ICD-10: Organization Perspective

Enabling Effective IT

ICD-10Process Impact

Do You Have This Knowledge Internally on Your Team?
Detailed knowledge of the potential impacts of ICD-10 implementation on each of the 80+ business processes identified in the Medicaid Information Technology Architecture business model, which has broken down the operation of the Medicaid health plan.
Most of these operations parallel those of a commercial health plan

Impact of 5010 & ICD-10 on Process

Claims Process
Organizational Units
Customer
Service
Product
Development
Care Management
Revenue
Mgmt
Reimbursement
Management
Finance & HR
Product Offerings to Members
Claims Management
Processes
Customer Service
Product Dev
Care Mgmt
Revenue Mgmt
Reimb Mgmt
Finance
Customer Services
SFA
Prodict
LMS
B2B
product
SCM
productinfo.
DB
ERP
CRM
SFA
Product
LMS
B2B
product
SCM
product
DB
ERP
CRM
Inv MGMT
ERP.
MES
Inv MGMT
ERP
MES
Enterprise Infrastructure Services
(Mainframe legacy, Portal, SOA, IDRS, LDAP, EAI, E-mail, IT Operations)
Enterprise Infrastructure Services
(Mainframe legacy, Portal, SOA, IDRS, LDAP, EAI, E-mail, IT Operations)
BPM models, simulates, executes, manages, monitors, & optimizes those Business Processes.
Real-World Business Processes span organizations, systems, and applications.
VisualizeCurrent & Future To Ensure Alignment, Value

Observe and manage queues in real time. Adjust staffing/efficiency, etc.
Configure Simulation Scenarios (Loads)
Generate detailed reports to assess process design. Export reports for external analysis.
Extensive cost-based, time-based, and unit-based reporting.

Example Process Model Artifact

Where to Apply Process Models
Ideal projects
Exception Handling (systems handle some work, people must deal with exceptions)
Corporate re-structuring, turn arounds
Best Practices (Process Excellence, Compliance)
Entry Point for Claims Upgrade Engagements
Significant Human Interaction

Conclusion
Planning & organizational readiness
Requirement audits & testing planning reduces risk
Ensure you have the knowledge internally and if not, augment with outside experts

Mike Arrigo
Managing Partner, CEO
No World Borders, Inc.
For more details, assessment info
ICD10@noworldborders.com
(Please send from your payor or provider email domain address)

Supporting Material

No World Borders
Track Record
Founded 2000
“Real life” experiences with NPI & HIPAA implementation
Recent success story: Excellus BCBS
Experience with several different Blues
Seven claims systems implementations
Backed by Private Equity Firm, Strong Financials
Consultants in U.S., Latin America, E.U., Asia
23

Capabilities Overview
Collective experience working with over 21Blues
WEDI experience
Blues Technology
ITS, Blue Exchange, Blue Squared
Software / tools vendor relationships, subject matter expertise
HIPAA 4010, 5010 regulatory, technical, and process expertise
ICD-10 regulatory, technical, and process expertise
Testing & validation tools & methods
24

Audit Quality Assurance & Testing100 Years Collective Experience in Audits & Quality Assurance
Healthcare, Financial and Pharmaceutical Verticals
Pharmaceutical & Healthcare testing
Configuration, Release Management
Test Data & Automation Management
Team participates in WEDI transaction & testing work groups
Accomplishments
Team created CCAP Testing Methodology
Tested all Major EDI Translators and Validators for 4010A
Original “Certifier of Certifiers” Process
Author of HIPAA Reference Book
Assisted Numerous Covered Entities and Vendors with Compliance

Capabilities Overview
Technical
Regulatory
Process
System / Vendor Impacts
Testing & Integration
“Agnostic, end to end approach”
26

Process & Compliance Expertise
Process improvement & claims implementation team consultants, former consultants to 21 Blues including:
Alabama
Blue Shield of CA
CareFirst
Excellus
Georgia
Louisiana
Hawaii
Indiana
Premera
Rhode Island
Nebraska
Michigan

Increase in data storage (active and backup) - 10 times the number of tables from ICD-9 to 10 plus alphanumeric and 2 more digits per code are added.
Data center & system upgrades
Backup
Network bandwidth
DR upgrades and plan improvements for after and during
Note: No World Borders system and data architects can assist if needed in this area. Our lead data architect built libraries to traverse SNOMED and ICD-9 for several clients and is developing ICD-10 sets and schemas now.
Duplication of code sets
2 year cut over which needs both versions to be available. This would need to cover both CM and PCS and the combination of both.
How to associate drug codes which may not be changing at the same time
Note: Have you determined their cut over strategy? Note: No World Borders system and data architects, HIPAA project managers, and other team members can assist if needed in this area.

Existing partners and coordination
Does the change have any impact on existing contracts or partners
Partner coordination for the cut over- CMS, insurance companies etc.
Note: Use consultants where necessary who assist you if needed in this area.
Opportunity projects
Are there associated projects that would be good to do at the same time? Examples centralize data centers, consolidate systems, and improve GUI etc.
Computer support and call center education and upgrades
Note: No World Borders has consultants who can assist you if needed in this area, particularly with expertise in IT and Business Portfolio management and prioritization exercises to ensure not only prioritization but senior management buy-in.

Icd10 organization strategy

by Michael Arrigo on Jun 30, 2010

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Icd10 organization strategy — Presentation Transcript