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 is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See and for more about the company.

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