ICD-10 Crosswalk using ICD-10 Predictive Analytics

ICD-Financial Risk Assessments should quantify both enterprise risk and ICD-10 risk related to each specialty and each area of ICD-10 clinical documentation.

Our founder and CEO Michael Arrigo wrote an in-depth macroeconomic analysis of ICD-10 financial risk entitled, Could ICD-10 Have as Big an Impact as the Mortgage Crisis?  Yes.  Here’s Why.   Later, he was retained by a group of PhDs in Economics, a law firm, and a leading healthcare IT firm to assist in a Federal Trade Commission involving ICD-10’s economic impact, access to clinical data, and computer assisted coding.

From this vision, and these experiences our firm developed a strategy, analytics solutions and partnerships to deliver Clinically Integrated Analytics ™ that enable you to understand not only your ICD-10 Financial Risk but your ICD-10 specialty risk and ICD-10 audit risk.  In addition we provide visibility into cost reducing opportunities in other areas of the health plan and health care provider’s operation using this analytic approach.

ICD-10 Crosswalk – Not a Panacea

Now that some health plans and health care providers have completed their ICD-10 Assessments many are trying to determine what to remediate and how to selectively prioritize ICD-10 clinical documentation improvement for health care providers.  Health plans are prioritizing their ICD-10 remediations and should be looking at their claims mix and contracted providers as well as test plans.  An ICD-10 Financial Risk Assessment should be a part of the ICD-10 Implementation Plan for a smooth ICD-10 transition.

Analytics can help.  We continue to caution HIPAA Covered Entities on using magic ICD-10 crosswalk tools.

ICD-10 Predictive Analytics

ICD-10 Analytics can be used to help prioritize reimbursement variation.

ICD-10 Financial Risk Assessment – Apply ICD-9 and ICD-10 Predictive Analytics Synergistically

When reviewing claims, our approach is unique in that we review reimbursement risk by specialty in ICD-9 vs ICD-10, out of network claims, clinical notifications for specialties where reduction of malpractice insurance opportunities exist, and other factors.

Therefore your investment in ICD-9 claims analytics and ICD-10 consulting is leveraged, and usually we find much greater savings than the client invests in fees for our work.

Contact us for more information.

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ICD-10 Financial Risk Assessment – Comprehensive Approach

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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