ICD-10 Assessments Today Need Fast Start

ICD-10 Assessments today need a faster start because there is less time to spare to get ready for the October 1, 2014 2015 deadline.

What you don’t know can hurt your reimbursement if you are a provider, and put you at risk of fines if you are a payor.   For most health care providers, we see many missed opportunities to prepare for ICD-10 by improving the clinical workflow and problem lists.  In fact, many electronic medical records systems encourage less specific documentation – that sends you in the wrong direction.

Therefore, we find it insufficient to hire an “ICD-10 project manager” to identify these issues.  A PMP-credentialed project manager is a good idea, but they do not have the clinical, coding, and IT knowledge or the ability to engage with physicians or assess healthcare IT system readiness.  A combined, multi-disciplinary approach with cross-functional involvement is important to successfully transition.  And YES – it is worth the money.

In addition to our ICD-10 Assessment program, we recommend starting with senior leadership training including C-Level executives, and physician training, combined with analytics that rapidly assess the highest risk areas of the organization, clinical documentation, and physician – coder interaction. Determining where the ICD-10 reimbursement risks are may depend mostly on whether your current documentation supports the extra specificity required. Knowing who to train (and we are not just talking about ICD-10 coders) is extremely important and missed by most organizations.

For health plans, ensuring that your medical policy and coverage determinations have rules to support ICD-10 is key.  For both payors and providers, we recommend ICD-10 financial risk assessments.

So today, ICD-10 assessments must prioritize the most important components first.  Coder training is obvious but there are several other areas of ICD-10 that aren’t necessarily IT related that should be examined.

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 https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

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