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

1. 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/

2. ICD-10 Topics Organization readiness Organization impacts Process impacts http://www.noworldborders.com/icd-10/

3. 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 http://www.noworldborders.com/icd-10/

4. ICD-10Organizational Impact http://www.noworldborders.com/icd-10/

5. Understanding Stakeholder Impacts Health Plan Providers Employers Members Vendors Regulatory Agencies http://www.noworldborders.com/icd-10/

6. Detail of all Business Functions & Systems. http://www.noworldborders.com/icd-10/

7. Organizational Capabilities Checklist Business & IT alignment Business roadmap IT portfolio management Unique knowledge of impacted business areas http://www.noworldborders.com/icd-10/

8. Organizational Capabilities Checklist 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 http://www.noworldborders.com/icd-10/

9. Organizational Capabilities Checklist Claims Adjudication CMS view Fraud analytics ICD-10 Strategy Data Warehouse http://www.noworldborders.com/icd-10/

10. Organizational Capabilities Checklist Business Intelligence Regulatory expertise Remediation areas checklist Training GEMS, Crosswalks Vocabulary & nomenclature http://www.noworldborders.com/icd-10/

11. Achieving ICD-10: Organization Perspective http://www.noworldborders.com/icd-10/

12. Enabling Effective IT http://www.noworldborders.com/icd-10/

13. ICD-10Process Impact http://www.noworldborders.com/icd-10/

14. 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 http://www.noworldborders.com/icd-10/

15. Impact of 5010 & ICD-10 on Process http://www.noworldborders.com/icd-10/

16. http://www.noworldborders.com/icd-10/ 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

17. http://www.noworldborders.com/icd-10/ 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.

18. Example Process Model Artifact http://www.noworldborders.com/icd-10/

19. 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 http://www.noworldborders.com/icd-10/

20. Conclusion Planning & organizational readiness Requirement audits & testing planning reduces risk Ensure you have the knowledge internally and if not, augment with outside experts http://www.noworldborders.com/icd-10/

21. 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/

22. Supporting Material http://www.noworldborders.com/icd-10/

23. 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 http://www.noworldborders.com/icd-10/ 23

25. WEDI experience

26. Blues Technology

27. ITS, Blue Exchange, Blue Squared

28. Software / tools vendor relationships, subject matter expertise

29. HIPAA 4010, 5010 regulatory, technical, and process expertise

30. ICD-10 regulatory, technical, and process expertise

31. Testing & validation tools & methods24

32. 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 http://www.noworldborders.com/icd-10/

34. Regulatory

35. Process

36. System / Vendor Impacts

37. Testing & Integration

38. “Agnostic, end to end approach”26

39. 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 http://www.noworldborders.com/icd-10/

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. 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. http://www.noworldborders.com/icd-10/

41. 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. http://www.noworldborders.com/icd-10/