Icd10 organization strategy

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Many health care consulting vendors focus on technology issues surrounding ICD-10, but the organizational impact, skills, capabilities of your team are paramount. This presentation, originally given by Michael Arrigo, CEO of No World Borders focuses on an organizational strategy to implement ICD-10

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Icd10 organization strategy

  1. 1. ICD-10 Organizational Strategy February 18, 2010<br />Mike Arrigo<br />Managing Partner, CEO<br />No World Borders, Inc.<br />For more details, assessment info<br />icd10@noworldborders.com<br />(Please send from your payor or provider email domain address)<br />http://www.noworldborders.com/icd-10/<br />
  2. 2. ICD-10 Topics<br />Organization readiness<br />Organization impacts<br />Process impacts<br />http://www.noworldborders.com/icd-10/<br />
  3. 3. Most Payers & Providers Are Under Estimating the Joint Requirement & Analysis Time for 5010 and ICD-10<br />Establishing organizational structure<br />Planning to replace, upgrading claims system<br />Secure compliance attestation from clearing houses <br />Review process impacts and improve process<br />Developing scoping & requirements documents <br />http://www.noworldborders.com/icd-10/<br />
  4. 4. ICD-10Organizational Impact<br />http://www.noworldborders.com/icd-10/<br />
  5. 5. Understanding Stakeholder Impacts<br />Health Plan<br />Providers<br />Employers<br />Members<br />Vendors<br />Regulatory Agencies<br />http://www.noworldborders.com/icd-10/<br />
  6. 6. Detail of all Business Functions & Systems. <br />http://www.noworldborders.com/icd-10/<br />
  7. 7. Organizational Capabilities Checklist<br />Business & IT alignment<br /> Business roadmap<br /> IT portfolio management<br />Unique knowledge of impacted business areas<br />http://www.noworldborders.com/icd-10/<br />
  8. 8. Organizational Capabilities Checklist<br />Claims Coding & Authorizations<br />Case Management Expertise<br />Experience with vendor chosen claims system<br />Experience with case management tools<br />Experience working with ICD-10 in other countries<br />http://www.noworldborders.com/icd-10/<br />
  9. 9. Organizational Capabilities Checklist<br />Claims Adjudication<br />CMS view<br />Fraud analytics<br />ICD-10 Strategy<br />Data Warehouse<br />http://www.noworldborders.com/icd-10/<br />
  10. 10. Organizational Capabilities Checklist<br />Business Intelligence<br />Regulatory expertise<br />Remediation areas checklist<br />Training<br />GEMS, Crosswalks<br />Vocabulary & nomenclature<br />http://www.noworldborders.com/icd-10/<br />
  11. 11. Achieving ICD-10: Organization Perspective<br />http://www.noworldborders.com/icd-10/<br />
  12. 12. Enabling Effective IT<br />http://www.noworldborders.com/icd-10/<br />
  13. 13. ICD-10Process Impact<br />http://www.noworldborders.com/icd-10/<br />
  14. 14. Do You Have This Knowledge Internally on Your Team?<br /> 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. <br /> Most of these operations parallel those of a commercial health plan<br />http://www.noworldborders.com/icd-10/<br />
  15. 15. Impact of 5010 & ICD-10 on Process<br />http://www.noworldborders.com/icd-10/<br />
  16. 16. http://www.noworldborders.com/icd-10/<br />Claims Process<br />Organizational Units<br />Customer <br />Service<br />Product<br />Development<br />Care Management<br />Revenue<br />Mgmt<br />Reimbursement<br />Management<br />Finance & HR<br />Product Offerings to Members<br />Claims Management<br />Processes<br />Customer Service<br />Product Dev<br />Care Mgmt<br />Revenue Mgmt<br />Reimb Mgmt<br />Finance<br />Customer Services<br />SFA<br />Prodict<br />LMS<br />B2B<br />product<br />SCM<br />productinfo.<br />DB<br />ERP<br />CRM<br />SFA<br />Product<br />LMS<br />B2B<br />product<br />SCM<br />product<br />DB<br />ERP<br />CRM<br />Inv MGMT<br />ERP.<br />MES<br />Inv MGMT<br />ERP<br />MES<br />Enterprise Infrastructure Services<br />(Mainframe legacy, Portal, SOA, IDRS, LDAP, EAI, E-mail, IT Operations)<br />Enterprise Infrastructure Services<br />(Mainframe legacy, Portal, SOA, IDRS, LDAP, EAI, E-mail, IT Operations)<br />BPM models, simulates, executes, manages, monitors, & optimizes those Business Processes.<br />Real-World Business Processes span organizations, systems, and applications.<br />VisualizeCurrent & Future To Ensure Alignment, Value<br />
  17. 17. http://www.noworldborders.com/icd-10/<br />Observe and manage queues in real time. Adjust staffing/efficiency, etc.<br />Configure Simulation Scenarios (Loads)<br />Generate detailed reports to assess process design. Export reports for external analysis.<br />Extensive cost-based, time-based, and unit-based reporting.<br />
  18. 18. Example Process Model Artifact<br />http://www.noworldborders.com/icd-10/<br />
  19. 19. Where to Apply Process Models<br />Ideal projects<br />Exception Handling (systems handle some work, people must deal with exceptions)<br />Corporate re-structuring, turn arounds<br />Best Practices (Process Excellence, Compliance)<br />Entry Point for Claims Upgrade Engagements<br />Significant Human Interaction<br />http://www.noworldborders.com/icd-10/<br />
  20. 20. Conclusion<br />Planning & organizational readiness <br />Requirement audits & testing planning reduces risk<br />Ensure you have the knowledge internally and if not, augment with outside experts<br />http://www.noworldborders.com/icd-10/<br />
  21. 21. Mike Arrigo<br />Managing Partner, CEO<br />No World Borders, Inc.<br />For more details, assessment info<br />ICD10@noworldborders.com<br />(Please send from your payor or provider email domain address)<br />http://www.noworldborders.com/icd-10/<br />
  22. 22. Supporting Material<br />http://www.noworldborders.com/icd-10/<br />
  23. 23. No World Borders<br />Track Record<br />Founded 2000<br />“Real life” experiences with NPI & HIPAA implementation<br />Recent success story: Excellus BCBS<br />Experience with several different Blues<br />Seven claims systems implementations<br />Backed by Private Equity Firm, Strong Financials<br />Consultants in U.S., Latin America, E.U., Asia<br />http://www.noworldborders.com/icd-10/<br />23<br />
  24. 24. Capabilities Overview<br />http://www.noworldborders.com/icd-10/<br /><ul><li> Collective experience working with over 21Blues
  25. 25. WEDI experience
  26. 26. Blues Technology
  27. 27. ITS, Blue Exchange, Blue Squared
  28. 28. Software / tools vendor relationships, subject matter expertise
  29. 29. HIPAA 4010, 5010 regulatory, technical, and process expertise
  30. 30. ICD-10 regulatory, technical, and process expertise
  31. 31. Testing & validation tools & methods</li></ul>24<br />
  32. 32. Audit Quality Assurance & Testing100 Years Collective Experience in Audits & Quality Assurance <br />Healthcare, Financial and Pharmaceutical Verticals<br />Pharmaceutical & Healthcare testing<br />Configuration, Release Management<br />Test Data & Automation Management<br />Team participates in WEDI transaction & testing work groups<br />Accomplishments<br />Team created CCAP Testing Methodology<br />Tested all Major EDI Translators and Validators for 4010A<br />Original “Certifier of Certifiers” Process<br />Author of HIPAA Reference Book<br />Assisted Numerous Covered Entities and Vendors with Compliance<br />http://www.noworldborders.com/icd-10/<br />
  33. 33. Capabilities Overview<br />http://www.noworldborders.com/icd-10/<br /><ul><li> Technical
  34. 34. Regulatory
  35. 35. Process
  36. 36. System / Vendor Impacts
  37. 37. Testing & Integration
  38. 38. “Agnostic, end to end approach”</li></ul>26<br />
  39. 39. Process & Compliance Expertise<br />Process improvement & claims implementation team consultants, former consultants to 21 Blues including:<br />Alabama <br />Blue Shield of CA<br />CareFirst <br />Excellus<br />Georgia<br />Louisiana<br />Hawaii<br />Indiana<br />Premera<br />Rhode Island<br />Nebraska<br />Michigan<br />http://www.noworldborders.com/icd-10/<br />
  40. 40. 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.<br />Data center & system upgrades<br />Backup <br />Network bandwidth<br />DR upgrades and plan improvements for after and during<br />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.<br />Duplication of code sets<br />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.<br />How to associate drug codes which may not be changing at the same time<br />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.<br />http://www.noworldborders.com/icd-10/<br />
  41. 41. Existing partners and coordination<br />Does the change have any impact on existing contracts or partners<br />Partner coordination for the cut over- CMS, insurance companies etc.<br />Note: Use consultants where necessary who assist you if needed in this area.<br />Opportunity projects<br />Are there associated projects that would be good to do at the same time? Examples centralize data centers, consolidate systems, and improve GUI etc.<br />Computer support and call center education and upgrades<br />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.<br />http://www.noworldborders.com/icd-10/<br />

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