Or, true confessions of a turnip-bleeder.
I've spent the last two days after work constructing an ingenious little system of dykes and levees and trenches, a few inches high and deep to get the water that collects here to go someplace useful. Driving home last night into the storm, I stopped to get guitar picks, so I missed the storm, but when I got home all the ground around my apartment was flooded. Waded out to the amusement of my neighbours and started cutting trenches with my Japanese handtool basically to make the water go uphill. Edison came out from next door and brought a bucket and a shovel and we took the water to the edge where we threw it out. (Native guy solution: move the water. White guy solution: dig up the earth to make it flow uphill. Between the two of us the water did recede.) Meanwhile, since the ground was wet, I built up the dam around my apartment and gave Helen, my neighbour to the north, one of her own since her apartment floods the same way mine does, too. It's fun for me, out playing in the mud. Better use of it, too, than cutting trenches out in the yard -- though they do serve to discourage the bicycle riding and running around by the kids. Run around in front of your own damn apartment. Heh. I may have to fill some of 'em in since that one lady two doors down uses a walker.
Today, even though it rained pretty seriously, it was all working well enough that I decided to breach the dam around my apartment to let the water flow in to the space in front of the living room window. I've got tons of seeds and things I've thrown out there and who knows what will grow. We'll find out in good time.
In other news my Alltel is now *so* slow that I can't even check email at home on a night I can't devote a solid hour or more to letting the gmail page load. Hence the bad link in the previous post -- I'm not an idiot, I just haven't been able to get anything to load for three days now and haven't seen it. I wasn't able to make that post the normal way, you see, I had to do it through email, and didn't know it didn't work the same until I saw it all screwed up just now. I'm starting to think it's not worth paying for their internet "service".
Speaking of lousy service, if you ever work with medical billing, watch out for NDC, which makes
Lytec, which is (sorry to say) industry standard software. (If you want to know why medical care in this country's fucked up, well sir, Lytec's a big part of it.) NDC is an extortion racket masquerading as a software company.
Here's how they work: you buy their product, Lytec, which is highly specialized medical billing software. A year or two passes and you purchase an upgrade. Among the "features" of this upgrade for which you've paid thousands of dollars is the *removal* of key basic features, such as the ability to import and export databases -- diagnosis codes, transaction codes, patient and provider files, fee schedules -- all the stuff that you just absolutely need to work correctly all the time -- from one practice to another. If you ever have to set up a new practice, you'll either have to code in all that information by hand, or pay for their exorbitantly priced service contract. Ridiculous, considering all the data itself is nothing but raw text.
I've spent much of the last two or three days doing just exactly that -- keying in diagnosis codes, one at a time, copying and pasting patient records, provider records, reference codes, transaction codes, you name it. All by hand. Bill finally broke down and paid for their lousy service contract, 'cause even though it might be justifiable in a business-type way to pay someone to do what I was doing *once*, doing the same thing *twice* is madness, and we've got more than one thing going on right now that would require me to do just that if we do not pay for it.
So basically, you pay for the software to begin with -- fair enough, I suppose. But then you pay for an upgrade and get handed an empty shell of a program which is in itself *useless*. There's no information in it -- universal standard stuff, just gone, 'cause they want you to pay for it *again*. No one will help you 'til you've shelled out hundreds more for a service contract. (Nothing for a big hospital, maybe, but for a small clinic? Terrible.) Having paid for the service contract, you're then allowed to get transferred back and forth between departments and get put on hold for 20 minutes at a time. (It should go without saying, in this business, if you've ever got a hankerin' to get put on hold, you're better off callin' an insurance company, which might just bring some money *in*!) And all the time that you're on hold, you get to listen, not to music, but to sales pitches. Not even the insurance companies are *that* brazenly scummy. NDC is. If and when you finally get through to the "support" person in the call center, they basically sit there dumbly and tell you what they're told to tell you -- you guessed it: that you need to buy a whole different ancillary program, because the current version of it (which you have) does not interface with the current version of Lytec, only the older version does. In other words: the program is *designed* to fail, *and* you have to pay for *downgrades*, *and* you have to pay to be told that you have to pay for downgrades.
The "support" division at NDC, which you have to *pay* to access, over and above what you pay for the software license, is *not* even really support -- it's just another way to get you transferred back into the sales department's queue (and make you pay on the way there). You buy a service contract and the service person's answer always boils down to this: you need to talk to sales about buying some more software. The software you'll be paying for will translate Lytec's underlying databases into -- you guessed it -- raw text. Yup. ISO 8859-1. But there's no way to just save or export the databases as raw text without buying the software, 'cause they are buried somewhere in the system. Bull-fucking-shit.
With cars, there are "lemon laws". There should be "lemon laws" for software. Lytec is a lemon, though-and-through. Where is the FTC?
If you ever have to set up a new practice -- if, say, the clinic you work for gets sold, or if new clients come on board -- NDC is gonna bleed you dry. That's how NDC does business, in a word: unethically. It's a pathetic little niche monopoly. Medical billing is a very specialized and fairly complicated little world, but a monkey could program software better, and even bad software can be marketed ethically. Too bad there's no
open-source medical billing software. If NDC put half as much into developing Lytec as they do into getting you to buy it -- and then "upgrades" that remove features, "service contracts" that transfer you to sales, and ancillary software that is *not* backwards compatible -- they might just have some people who could recommend it eagerly. As it is, I give it a 3 in ten because, after dozens of hours of unnecessary work, it's not impossible to print a claim that may get paid.
You want to know why your 50-minute hour with the doctor cost $145? Well, partly because I had to spend two solid days transferring data manually between two separate practices open in concurrent versions of the same software before my boss paid his own hard-earned money to the software vendor that we all know is defrauding him so we could finally get everything set up so we could spend the necessary minute and a half actually entering the data relevant to your claim for that date of service and submit it to your insurance company which may or may not pay because they're in the business for their shareholders of denying claims on any grounds they can.
Healthcare for profit. Grand idea, isn't it?
Imagine being able to buy software and have 30 or 90 days (or more) of tech support *included* in the contract. Imagine those 30 or 90 days starting, not when you license the software, but when you first need to call them. Imagine service techs that *only* help you through whatever problem you've got without trying to sell you *older* supporting software than what you've already paid for newer versions of. Imagine not having those problems in the first place 'cause they haven't been hard-coded into the program to begin with. Imagine being able to code *out* the problems that inevitably *will* crop up, even in software designed to *work*. Imagine upgrades that *add* useful features instead of *removing* vital ones.
Too bad the medical and mental health fields don't use Macs 'cause it'd save a lot of problems all around. I seriously doubt if there is even software available in that field for the Mac. But it sure would be nice. Sometimes I swear we'd be better off standing at desks with huge leather-bound ledgers and inkwells.
The last month at work has been touch and go businesswise -- suddenly *everything* was in transition. I think the worst is over with. Maybe. I *do* know we submitted 35 grand in claims today, which hasn't happened for a long damn time. Too long. There's a feeling of accomplishment and excitement when we've got the festive pink HCFA-1500s strewn about the room. Maybe it's seasonal, who knows. I guess I will find out. But this last month or so has been insane -- new practices getting set up, barely established practices getting sold, others coming perilously close to going out of business under the weight of their own bloated mismanagement, and people quitting in a huff and sabotaging computers. I don't care what you think, I think it's *fun*.
I don't write much about work. It's pretty interesting, really. Saying it's a data entry job is like saying a mechanic just has to know how to turn a screwdriver. But the confidentiality requirements are such that, well, I'd just plain have to make up half a dozen names or more if I wanted to do it right. But it's OK for me to talk nasty about Lytec, 'cause lots of different companies and clinics use it, and it really plain old sucks. And it's OK for me to say that getting money out of Blue Cross is like getting blood from a turnip, because it is.
You should see what Blue Cross puts us through to get IOPs paid. We can't use the HIPAA mandated H0015 code, because, well, BCBS is "special" enough that nationwide industry standards don't apply to them and they get to declare that they won't pay IOPs billed with the standard code. You can fight it with them to a point, and even call the State Insurance Commissioner, but eventually it comes down to claims just piling up, so you either learn to beat them at their own game and get the claims paid or just go out of business. So you have to use the generic 90899 CPT, and attach an itemized walkout statement with each HCFA-1500 (stapled in the center at the top), and it's not enough to just attach the statements, you have to print "ITEMIZED STATEMENT WITH DESCRIPTION OF CPT CODE ATTACHED" in the upper right hand corner of the HCFA-1500, send it to the local office, from which (if you're lucky) it'll get forwarded to the patient's "homeplan", where if you're lucky, they won't send you a letter demanding a description of the code (that's why you print it on the claim), or tell you the provider isn't contracted (when you know she is), or that the date of service is outside effective dates (which it may be, for all you know), and will sooner or later pay the contracted portion of what you billed them for in the first place.
It is a game. You get to where you're following a hundred different claims and patients and providers in your mind at any given time. Either everything's all caught up for the moment or everyone wants everything right now. Kind of like Foxes but it's a lot more satisfying than knowing "we stayed open" and "no one went to jail".
There's one patient -- one only -- who I actually know in the outside world -- or did, before he dropped off the face of the earth and went into IOP. (I still don't know why he's there; as a claims processor it's none of my damn business.) I haven't seen him in ages and he doesn't know I'm processing his claims. But when I see his name pop up oh once or twice a week I do remember, that's why it matters that I enter everything correctly, follow up with insurers, get claims paid, keep charges and payments moving through the system -- so that on top of whatever hell he has to have been through to land in IOPs in the first place he doesn't get slapped with a "PAST DUE" bill for thousands of dollars he thought that his insurance would pay for. Patients sometimes declare bankruptcy under the weight of these bills. If I do my job right, this guy will never have a clue I'm even there. The nightmare will just end. And when I've gone a month or two without seeing his name, I'll let it go. Now multiply by several hundred for all the patients that our clinics see.
It is still "harm reduction". I don't stop people from doing stupid things. I do not even try. But when they do I deal with it and make it as painless from where I stand as best I can. It's late. I'm going to bed.