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Complete healthcare financial and regulatory solutions from the market leader

 

 

ICD-10 Consulting Assessments and Implementation Planning

 

At No World Borders, we have a track record of delivering HIPAA 5010 and ICD-10 Assessments, ICD-10 impact analysis, and ICD-10 implementation plans on time and on budget with excellent results.  You can read about our success stories here. 

The Wall Street Journal recently covered our company and described ICD-10 as the "Y2K" problem in Health Care.  We are a thougtht leader and innovator in the field.  Better yet, don't waste any more time - contact us now for help with your impact assessment, implementation planning, medical policy and regulatory review or other key areas you need to address now. 

 

Wall Street Journal

Please view the video interview below from one of our recent clients.

 

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ICD-10 Readiness Review Consulting

Business Roadmap Development

As part of the project scope No World Borders feels it is imperative to map out the process for organizing and achieving change. At this stage, clients need to make sure that there is sufficient urgency within the organization to drive change forward. This will be critical to getting the ball moving. We need to design an approach to make sure that happens. In addition, we need to help form a guiding coalition that can firm up the change vision, develop a roadmap of change initiatives and organize the teams of people responsible for getting the work done.

Training

We provide a series of training sessions, which provide key information about the ICD-10 code set, how to use it, how to benefit from it, and what the implementation steps are. There are 12 Training Segments in the entire program.

High Level Review

Early assessment helps you gain a strong understanding of how ICD-10 will impact your organization. We focus on people, business processes and technology to assess the impact of ICD-10. It is a critical part of any ICD-10 initiative since ICD-10 has the potential to impact so much of your business, including programs and systems for claims, analytics fraud detection, enrollment, eligibility, benefits, pricing, sponsor contracting, medical management, provider electronic data interchange (EDI) transactions and other areas.

In-Depth Assessment & Gap Analysis

Clients need to know whether their detail assumptions have any fundamental variances from best practices and regulations. An in-depth analysis of complex artifacts may include a review of underlying HIPAA 5010 EDI transactions, and ICD-10, trading partner coordination & testing plan review, and as–is & to–be process review.

Implementation Planning and Design

This phase takes the outputs (strategic direction, high level review) to develop the detailed design. The design focuses on business processes that require modification and IT applications that require remediation and replacement. We create a detail project plan based on the design that carefully balances all factors.

Implementation and ICD-10 Compliance

This is the final step in our process to help you achieve ICD-10 compliance and realize efficiencies while mitigating risk. During this phase, we make modifications to implementation plans based on recommendations from the Planning and Design phase. Our experts can help guide ICD-10 testing and trading partner launch.

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Best-practice Approach for ICD-10 Transition

No World Borders recommends the following tactics for best results with the transition to ICD-10.

  1. Early engagement of stakeholders and partners to gain buy–in early in the process
  2. Develop an enterprise-wide assessment to understand full organizational impact.
  3. Use the assessment to identify opportunities for innovation and process improvement.
  4. Determine the ICD-10 implementation strategy & visions for business architecture, technical architecture and data architecture.
  5. Determine the effort required and plan to implement your strategic vision while meeting the October 1, 2014 compliance date.

ICD-10 Implementation Details

No health care company we know of can afford to wipe away years of heterogeneous legacy systems and start anew across its entire enterprise, even faced with sweeping changes in federal compliance rules and new standards. This quandary poses challenges left unaddressed by general equivalence mappings (GEMs), cross walks, and other supporting documents alone. Some systems will need to be retired and replaced, some retrofitted. ICD-10 ReadinessTrue, many firms are just embarking on 5010 conversion and correctly state that process impact does not come into play significantly until ICD-10, however the co-mingling of these efforts and the early development of requirements that embrace both can lead to efficiencies later in the ICD-10 implementation cycle.

Integrated Perspective on Migration

Partnering with a company that understands all aspects of the move to HIPAA 5010 and ICD-10 will be key. At No World Borders, we see the health care landscape from all perspectives; we help you ensure that all entities, from trading partners to members, can move more smoothly to these new standards.

  • Health Plan
  • Providers
  • Employers
  • Members
  • Vendors
  • Regulatory Agencies

Integrated Method to 5010 and ICD-10 Implementation

Implementing ICD-10 and meeting the 5010 milestone successfully means taking an end-to-end approach to operational systems and resources. Taking the time to build a strategic plan that includes people, process and technology allows payers to look for opportunities to break down organizational barriers and use technology as a way to create new efficiencies. The payers that successfully accomplish this are the ones that will emerge as the market leaders of tomorrow.

Our experience strongly suggests that payers develop requirements and plan for 5010 and ICD-10 concurrently to avoid additional expenses, resources, time loss and redundancy in analysis. Start now with an ICD-10 readiness review.

No World Borders (NWB) end-to-end ICD-10 implementation services include ICD-10 assessments and other services such as:

  • Readiness Audit Framework using web based data collection and surveys
  • Strategic business roadmap services and ICD-10 implementation gap analysis
  • Service Oriented Architecture (SOA) IT deployment consultants
  • ICD-10 business roadmap consulting and medical coding ICD-10 training
  • Best of breed integration technology, analytics
  • Governance and ICD-10 reimbursement models
  • Medical management planning and remediation
  • Expert advice from nationally recognized U.S. based experts in health care and regulatory compliance

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People, Process, & Technology—Strategic Implementation of ICD-10

The significant increase in code classifications will affect how departments function within themselves, with each other and with outside organizations. As payers take the time to become educated about ICD-10 and 5010, it becomes clear that the impacts are not contained within one area of the business, such as claims.

In fact, they are broad reaching, unavoidable requirements ICD-10 Integrated Approach that will greatly impact how payers operate moving forward. A workflow analysis to identify potential gaps in process, and redesign of workflows and product configurations to accommodate those changes is critical to preparing for ICD-10 implementation.

Disconnected process can lead to missed requirements, workflows that do not support the transaction and code transitions, and configurations that result in claims being denied or billed under both coding systems. Consider the effects that ICD-10 will have on Explanation of Benefits (EOB) statements.

This seemingly simple piece of the puzzle has far-reaching impacts across people, process and technology. The provider will need to give the proper codes. The payer will need to accept those codes to determine payment and issue an EOB. Members need to receive communications that educate them about new information appearing on their EOBs. And customer service representatives need training and preparation to intelligently answer members’ questions.

Many organizations skip this analysis stage and go right to implementation. Spend time to assess the impact of the codes—including their cost—upfront, by completing a gap analysis on the expected workflow changes. Identify key benchmarks and measurements, that technology changes must support, to help build the credibility and trust needed to implement changes for ICD-10 support.

With a strong understanding of the people and process changes needed to support ICD-10 implementations, payers and providers can next evaluate the technical impact of the change and determine the best way to meet those changes. As we and our clients are learning, changes in technology required by ICD-10 and 5010 compliance will affect all core areas of payer operations, including patient care, pharmacy, provider systems and reporting.

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New Standards Experts, Judgment & Experience

Electronic Data Interchange and ICD-10

Our team’s relationships with Chief Medical Information Officers, the Workgroup for Electronic Data Interchange (WEDI), ANSI HITSP and other groups give us visibility into current and future state standards.

While knowing the world of new standards is important, having the judgment and experience to know what is practical and how to achieve it in a heterogeneous organization and computing environment is essential.

Our HIPAA Migration Services include:

  • Business Strategy and Process Re-engineering
  • Organizational development to establish a culture in your company that both enables and embraces change brought about by HIT.
  • EDI Evaluation and Data Management, including Use Cases and Step by Step Audit Frameworks
  • Strong regulatory, standards, and systems perspectives to provide the realistic mentoring to our clients
  • Ontology of knowledge of the standards, on-staff consultants, and a network of over 450 health care IT professionals with relevant experience.
  • Health information exchange solutions design based on service oriented architecture, HIPAA EDI data transport, and HIPAA coding standards.
  • Systems Integration
  • Training & Education

Overview - Health Care Solution Offerings

  • Business continuity planning
  • Change management
  • Claims systems implementation and process design
  • Computing infrastructure, service level agreements
  • Customer relationship & information management, call center infrastructure
  • eCommerce, online ordering systems
  • EDI and data coding standards for health care
    • 4010 to 5010
    • HIPAA transaction engineering design review in light of new standards: (997, 999, 837, 835, 834, 820, 278, 277, 276, 271, 270)
    • ICD–9 to ICD-10
  • Enterprise architecture using standard frameworks such as TOGAF
  • Financial & employee systems integration
  • Governance - IT, Project, Corporate
  • Health care facilities estate environmental sustainability and energy planning (LEED certified green building assessments)
  • Lean / Six Sigma facilitation and adoption
  • Legacy system retirement and transition
  • Pharmacovigilance, Adverse Event Reporting
  • Portfolio management in IT
  • Process visualization, innovation, and improvement
  • Revenue management & payment systems
  • Security audits & training (PCI, OWASP, others)
  • Supply chain and third party logistics (3PL)
  • Workplace planning solutions, (portfolio, maintenance, transaction, lease & accounting management)

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Helping Your Success, Achieving Results

At each stage of your implementation you may leverage our expertise to supplement your existing staff in handling time-critical projects as needed. Some of our roles can include:

  • Serving as an extended arm of your team
  • Host education, training and other events for your team and partners
  • Capture lessons learned and product feedback
  • Provide detailed guidance to customers on best practices captured from hundreds of implementations

From initial configuration and setup to training, education and ongoing support, No World Borders provides a full spectrum of services to ensure that our clients' efforts are successful.

Our Role in Your Success

Our experienced and professional services team can support and augment your internal 5010 migration and ICD-10 upgrade

Partner for ICD-10 migration

initiatives in the following roles:

  • Audit and review of migration requirements, whether developed by us or the client
  • Project Management
  • HIPAA Migration Readiness Survey
  • 5010 Migration Strategic Planning
  • 5010 Standards Subject Matter Experts
  • 5010 Migration Testing and Validation
  • As Is and To Be Process Models, Facilitation, and Re-Engineering
  • Review of Requirements Development Process

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Who is No World Borders?

No World Borders is a full service-consulting firm with a ten-year track record helping some of the most successful companies in the world, without the overhead and conventional model of large consulting firms. We have strong financial backing by a leading private equity firm and an experienced management team with a well-respected advisory board.

The No World Borders client services team is staffed with industry experts with in-depth knowledge of claims systems and supporting workflows and work streams which support provider management, customer service, financial systems integration, and the core claims process and standards. We work with payers in the U.S.A., Latin America and the E.U. to help optimize their process, data, and local regulations.

Our consultants work with clients to ensure successful implementation of our partner solutions, and completion of smooth migration to HIPAA X12 version 5010 and ICD-10. Our consulting services provide experience and experts to cost–effectively meet your 5010 migration requirements.

Our experienced team understands your business and technology. Our consultants have an average of 15 years experience, and are available on an interim basis to save cost when you need it.

We help you find efficiencies and reduce cost. We are experts at business process modeling (BPM), a visual method to describe changes to your business. We create a shared vision of success within teams to help ensure initiatives produce a win for you and your customers.

We make the complex simpler by helping you see how to apply improvements in your organization, process, and technology to achieve business goals. We perform assessments with easy to understand recommendations, reports, and visualizations. We help solve problems with large software implementations for

teams by providing leadership, project and process management.

We are experts at helping businesses change and innovate, including turn around, go to market, and re-structuring. We help leverage market inflection points in your business by finding ways to assess, grow, change, or right-size your work force.

We use an innovative, technology-oriented solution approach. Our team can provide cost effective solutions, enabling you to seize opportunities quickly and create efficiencies.

We bring tested, proven frameworks and methodologies that have worked at other health care companies to you to save time, cost and eliminate errors so that the adoption of HIPAA 5010 and ICD-10 goes more smoothly.

We are experts at finding cost efficiencies in the market, helping you identify niches that assist you in reaching your audience and developing prospects more efficiently than your competitors. We use best practices such as ITIL and Lean to help reduce risk, improve quality and predictability and save money.

Selective technology partnerships help provide timely, relevant solutions. We work with market leading software and service innovators to implement solutions in a variety of markets.

Our team has cross-industry experience with a broad range of clients. Our advisory and assessment services in management consulting, IT consulting, solution design, human and investment capital, and outsourcing have been provided to clients in the automotive, financial services, retail, apparel, consumer electronics, healthcare, medical device, pharmaceutical, enterprise software, telecommunications, entertainment, internet media and online marketing industries. Broad insights gained from cross industry experience make our consultants more valuable and impactful for your business.

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Organizational Capabilities Checklist

From business process modeling to data warehouse and analytics and disease management, our firm understands the competencies required to harness ICD-10 and improve the benefits that can be reaped from making the transition. Please request a proposal for an assessment.

Vendor Selection and Assessment for ICD-10

Prioritizing vendors for the move to HIPAA 5010 and ICD-10 is critical. No World Borders has lived through the challenges of making these decisions with clients like you. We can help sharpen your strategy to set the right priorities.

Our history of excellence and results in different industries make our insights more valuable.

Our team and our partners work with the most successful and best-known brands in the world in health care:

  • Abbott Medical Optics
  • Agile Software
  • Alcon
  • Baxter Biosciences
  • Blue Cross Blue Shield independent companies
  • Eli Lilly
  • Genzyme
  • Kaiser Permanente
  • Leading IPAs, Hospitals
  • Medtronic
  • Met Life
  • United Health
  • US Labs

Rely on Business Experts Who Know IT Health

At No World Borders, we understand the impact ICD-10 will have on your company. Over 10 years, No World Borders has partnered with large and small business system integrators; and worked with 25 of the top health plans in U.S.

Our experts are familiar with the Centers for Medicare and Medicaid Services (CMS) in support of the Medicare program has positioned us on the forefront regarding ICD-10 standards.

We are experts in health care people, process, and technology. Through knowledge of American National Standards Institute x12 (ANSI x12), National Council for Prescription Drug Programs (NCPDP), Workgroup for Electronic Data Interchange (WEDI), and other organizations, we understand the ICD-10 complexities and how these issues translate to your organization.

Our ICD-10 Readiness Solutions, a blended approach that includes ICD-10 readiness span for entire ICD-10 migration lifecycle.

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Benefits of ICD-10: Summary

Why the switch from ICD–9 codes to ICD-10 codes? While the health care industry has used ICD–9 codes for over 25 years, the code set has not been able to keep up with changes in medicine…newer conditions, and newer ways of treating patients. The ICD-10 diagnosis code set has been designed to capture much more specific information on the patient’s diagnosis. The procedure code set will enable hospitals to record much more specific information on procedures performed and devices used.

  1. ICD-10 provides better information on diagnoses and inpatient hospital procedures
  2. This data is routinely collected on claims
  3. The data can be used to improve many of the functions of the State Medicaid program

Rationale for Use of ICD-10

  • ICD-10 replaces a 25–year–old code set that has failed to keep up with modern terminology and practice
  • ICD-10 provides detailed information on a patient’s condition through specific diagnoses
  • ICD-10 provides a more specific and modern approach to classifying inpatient hospital procedures

Opportunities with ICD-10

  • With the greater specificity of ICD-10-CM diagnoses and ICD-10-PCS procedure codes, claims information can be used for data capture and analysis
    • Enables collection of additional data from providers
  • Medicare and Medicaid agencies can take advantage of this better information for improved quality measures
    • Upgrade current analytics of diagnoses and procedures, enabling access to improved CMS reimbursements

Range of Applications for ICD-10

  • Improved care management of beneficiaries
  • Boost efficiencies by identification of specific health conditions, diagnoses, and procedures
  • More effective coverage and payment determination
  • Better data for fraud and abuse monitoring
  • Links to electronic health records (EHRs) and additional information
  • Strategic planning for member, provider, and benefit service improvements
  • Performance monitoring and increased capacity to report quality measures
  • Quality assurance of clinical and administrative processes

Better Coverage and Better Payment via ICD-10

  • The more specific information provided in the ICD-10 codes presents an opportunity for coverage and policy revisions
  • Policies can now pinpoint more specific conditions and more specific procedures
  • Medicaid programs can make better decisions on whether to cover procedures based on better diagnosis information on the claim
  • Medicaid programs can more accurately pay for procedures based on specific diagnoses and the severity of the diagnosis

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Improved Strategic Planning Enabled with ICD-10

Let’s now consider a longer-term opportunity – Using the better information provided on claims for strategic planning. This is another chance to start making data-based decisions for major program changes. Revised benefit packages, caseload trends, changing provider mixes, etc., are all decisions that can be looked at and possibly supported by data that is being routinely collected on claims.

  • Strategic planning is another opportunity for use of the better data that ICD-10 will provide
  • As data is collected, trending can begin and support strategic planning for:
    • Relating beneficiary demographic information with conditions
    • Looking at provider caseload trends by condition
    • Determining better benefit packages for the Medicaid population

Other Benefits and Opportunities via ICD-10

  • Improved visibility into fraud & abuse via better data and analytics
  • Quality and performance analytics
  • Links to electronic records and additional information
  • Improved efficiencies with better ability to determine which procedures are most appropriate, and streamlined information for payment

© Copyright 2013, No World Borders, Inc All rights reserved. Trademarks used in this brief are the property of their respective owners. All information is believed to be correct at the time of publication but No World Borders makes no warranties based on this document as to the capabilities available.

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© 2014 - No World Borders. All Rights Reserved.Email: info@noworldborders.com