Born This Way #1, Mubarek Resigns, Health Care Reform Continues

January 19, 2011 was the day that the U.S. House of Representatives voted  245 to 189 in favor of repealing health care reform, but most agreed that this was symbolic only.

Weeks after that, the U.S. Senate voted down a Republican attempt to repeal reform.   The news of this domestic development which impacts hundreds of millions of Americans and $ Billions in U.S. spending disapeared with a whimper.

As of February 11, 2011 the international news of Mubarek resignation is the most popular topic on the Internet.   A peaceful transition will keep the suez canal open and avoid a spike in oil prices, but likely will have little impact on our domestic situation.  Lady Gaga’s new song Born this Way is the top tune on iTunes.

Sensationalism creates a sense of temporary urgency to know more.  Mubarek steps down, Lady Gaga has a new hit.  However, in health care reform more than 50% of all health care companies in the U.S. are not prepared for a new reimbursement system called ICD-10.  This is a slow steady march to what could be a sensational event in the future.  If a large percentage of health insurance firms and hospitals cannot submit or process claims in the new medical coding system, then it could lead to the next Federal bailout – but this time in health care not financial services.   There is immediate gratification in reading headlines, but long term the diffcult situation that many firms are having trouble facing is that the future of the entire health care payment system is in jeopardy because a large portion of all companies are behind.  This is due in part to complexity, part due to cost, and part due to distraction with other regulations that also must be met.

So, while the world searches and reads about Mubarek stepping down today and Lady Gaga, we think more of the U.S.  should be searching for information on whether their hospital or insurance company are on target to achieve health care standards.  Some of these standards, by the way, are completely separate from health care reform and were actually mandated in 2008 before Obamacare.

These are:

1. Meaningful Use – ensuring that hospitals, physicians and others are ready to go electronic with “E.H.R.”

2. Ability to property enter a diagnosis as well as a medical procedure code using the new ICD-10 system by October 1, 2013

3. Ability to properly send or receive a claim for health care services via a new EDI standard, HIPAA 5010 by January 1, 2012.

4. Ability to create the systems that ensure better coordination of care and quality measures – key to moving from a reimbursement focused health care system to one where outcomes – “quality” are the drivers, and where a patient can move from one medical center to another knowing their entire medical record will be accessable by health care providers at any point of care.

Michael F. Arrigo

Michael Arrigo brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health IT, and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations who provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and medical billing, fraud damages, as well as electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, medical malpractice, insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software SA (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls IT audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and is published in Healthcare IT News.

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