Wednesday, September 7, 2011

Mysterious Codes

No news is good news in Sparkland.  All is well.  My energy levels are decent and my back is in good shape.  Ken is hanging in there, waiting for his cardiologist appointment.  He has learned to live within the limits set by his atrial fibrillation until it can be treated. 

Work is pretty good, all things considered.  I am only trying to deal with one semi-crisis at the moment.  This situation was brought to us courtesy of the government.  It is a taxpayer-funded crisis.

It's common knowledge that Canada has a public health care system.  How it works in Ontario, my province, is that doctors submit their billings to the government via a series of codes.  X units of H345, Y units of J567.  The Ministry of Health's computers validate the billings.  If the code combinations abide by all the programmed rules, the MOH deposits the appropriate amount of cash into the doctor's bank account.  If the billings do not abide by the rules, we get back error codes and empty pockets.

Our lovely government published a new set of billing rules.  I found out about the changes at the end of the day on August 30th, for changes to be effective as of September 1st.  It's my understanding that the change bulletins went out to all the technical billing agents on August 30th in the morning.  This is what I like to call INSUFFICIENT NOTICE. 

The old rules were complicated, but we understood them.  The maximums, the dependencies, the limits on procedures per patient per 12-month-period, etc.  The new rules are just as complicated, and now we are confused.  The Schedule of Benefits is written in a dialect of legalese which is difficult to understand.  Considering that the income of our business depends upon a clear understanding of these rules, this situation is causing no small amount of panic among the ranks.

It will be sorted out eventually, even if it means that initially we get back a lot of error codes.  My biggest frustration is my own lack of knowledge.  I am responsible for supervising data entry for billing, and I knew the old rules backwards and forwards, but I sure couldn't tell you which procedure X478 stands for and why it may or may not be mutually exclusive with X479.  In other words, my understanding does not go deep enough for me to interpret the Schedule of Benefits myself.  Every doctor I've spoken to has their own personal interpretation of the changes.  That's why we're down to trial and error for figuring out what we can and can't bill.

Usually the system works very well.  I only wish that they'd given us a little more lead time to figure out these new rules before going live with them.  One month would have been nice.  We have a pretty good government, especially compared to what's going on elsewhere in the world and all, but still.  Sometimes it is time to complain.

12 comments:

Warped Mind of Ron said...

Ummm... 1 day notice?! That's crazy talk!!! Well it would be crazy talk but nobody knows the codes for crazy anymore!!! Arrrrgggg!!

Lynn said...

Yes - I agree - the notice on that is too short. I'm intrigued by that system though. It sounds so much better than our system in the US.

Jameil said...

Compared to a day, a WEEK would've been better! That sounds like a lifetime compared to ONE DAY!! Ugh.

DarcKnyt said...

Don't feel too bad, Spark. I'm having a nightmare day too, and it's been that way since about 7:00am. Hang in there. You'll get it. And to make double sure, I'll say a prayer for you, too.

G said...

Package stores in Connecticut had pretty much the same thing.

A boatload of new liquor taxes went into effect on July 1st.

With less than a week's notice.

The owner of my local store spent the next few days until 2 in the morning inventorying every single item in his store so that it could be properly taxed.

Pixiebaby said...

Wow! That's insane. I wish you luck in getting the hang of the new system before you go totally bonkers. Hang in there and remember to breathe. *hugs*

DarcsFalcon said...

Oh I cry foul! No fair changing the rules in the middle of the game without warning.

Hopefully you'll get it all figured out quicker than you think you can. :) I'm rooting for you Spark!

Granny Annie said...

Yikes!!! Don't get me started on health care.

wigsf3 said...

I wonder how much money the gubment spends on consulting, reviewing and amending existing systems. This is the single true waste of money by the gubment. How much is consulting truly worth?
This consulting agencies are private companies hired by our elected officials to make recommendations to our elected officials on how revenue should be dispersed on various gubment projects.
Why are we electing politicians? Shouldn't we just vote for consulting firms instead. Streamline. Cut out the middle man.
I'd wager that every major gubment scandal in this country can be traced back to a consulting firm. Scandals like eHealth, the long gun registry, ad-scam. Wait a sec... When was the last gubment scandal that did not involve consultants?

Sparkling Red said...

Ron: Crazy would be assigned a diagnostic code as opposed to a procedural code. ;-)

Lynn: In my opinion Canada's health care systems is far from perfect, but I wouldn't trade it for the US system.

Jameil: I didn't even mention that the head of accounting had just started a two week vacation overseas when the changes were announced, so we haven't had the benefit of her wisdom. She'll be coming back to a fine mess on Monday!

DarcKnyt: I hope your day got better! Mine did. The billing codes are not any more clear, but at least I found out that the company that supplies and supports our booking and billing software will probably survive their bankcrupty proceedings. Sheesh!

G: Oh man! That's brutal.

Pixiebaby: Thanks! I will - remember to breathe that is. Fortunately my boss seems committed to helping with the situation, rather than leaving me responsible for a mess that I am not equipped to handle.

DarcsFalcon: Thank you. The punch line is that if we called the MOH for guidance, most of their employees wouldn't understand the new rules yet either. Heck, they barely understood the old rules!

Granny Annie: I'll try not to. ;-)

wigsf: Yup, that's pretty much how it works. The politicians are like a screen between the public and the people who actually have all the power and influence.

LL Cool Joe said...

I'm glad your back is better and you have more energy. I could do with some of that!

Jenski said...

Hope you and your office are getting the code switch under control! I always wonder about seemingly random things like that when they happen. Doesn't the government have something better to do with their time than switch something that seems to work fine?