Thursday, July 13, 2006

Accountability

My steps, by the way, are at 6720 thus far and it is now again, on the bus that I am writing this.  I am listening to Gunther's "Ding Dong" song. 

Now, for the healthcare misc stuff update.  We have 3 full time people just checking on what's going on with our claims when they go out the door.  Basically they are tasked with finding out why a claim didn't get paid.  One of the very common things is "Insurance says they don't have the claim".  Naturally, we rebill the claim.  Then it escalates from there.  The breakdown of the system has happened in serious ways by now.

Colorado has laws saying the insurance companies have 30 days to pay/respond to a claim if it is billed electronically.  We bill %90 of our claims electronically.  Insurance companies that were supposedly billed electronically just flat out say they don't have the claim.  We have a problem.

Our steps in investigating this is through our billing software vendor.  I don't disclose whom they are, but I will say this...they SUCK.  A few claims we are finding have indeed made it to the insurance company and that's all well and great.  The problem with a few of our claims is that they are making it out of our facility to our billing software vendor and going precisely no where.  Or at least, we have no proof it went anywhere.  I don't know if it's just because we are a "rural" hospital or what the deal is, but if we're being hamstrung on our end that really blows.  I am pushing my boss for a different system, and apparently he's more of an advocate for a different system than even I am.  However, this isn't like some faulty software bug or some kind of entertainment software glitch....this is people's lives being affected by a billing system. On our end we're doing everything we can to do this correctly. That's not PR speak either, we really want this stuff to work because we want the money. It's less self pay work, it's happier patients who are prone to come back to our facility, it's our reputation on the line. No hospital wants to have a crappy reputation in the community. Our people want to go out into the town and be like "Yeah, I work at the hospital, and it's cool". Instead we are often tied to a reputation of sordid billing practices when here we are busting our asses. It's really a disappointment. Plus we want to have nice equipment and good salaries. This stupid billing system is impeding that. Our finances aren't "bad" at least, they're just not lining up with our goals. That's the dissappointment factor kicking in.

I am very pleased with how senior management is handling this.  They have the attitude that we absolutely have to hold either the insurance companies or the billing software vendor accountable. They are very supportive of our ideas to do make that happen.  My boss in fact has voiced his support for getting people's heads together in figuring this stuff out. I think I'm very happy where I'm at ultimately. The place is a good place to work, just not with one of the vendors we have.

In other info, I have the Sixtyforce emulator pretty well figured out. There are a few ROMS that aren't compatible. This honestly surprises me given the length of time we've had to emulate the N64. On the other hand it doesn't, because the guy is writing assembly code for PowerPC. This isn't like going in and changing a few lines of code to make a universal binary. When you code in assembly, you are coding for PowerPC all around. What he's doing in trying to make a universal version of sixtyforce is akin to taking the same newspaper and making the english version also read in arabic and having no translator software to help you out. Given that it's originally written for PPC, it makes perfect sense as to why it isn't flawless. With the current x86 emulators for Windows you could emulate N64 stuff on a P2-450 with a Voodoo2, but for OSX that kind of development just hasn't been around as long. Well, since I just..almost fell asleep...I am putting the laptop away and getting a bit more comfortable...and then falling asleep for real. I shall update the blog later with my actual step figure.

8293


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