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2004-03-25 - 9:33 p.m.

*OH* how things can change so fast!!

(Note to self - do not gloat. Gloating brings bad karma.)

I went back to work today. I clocked in at 7:15. Just my adorable way of saying "Pick a new bogus infraction to write me up for, Sparky. Your paper trail ends here."

I was anxious to see what my trusty co-workers were able to come up with for billing codes in my 3 day absence. I expected them to just wait the three days for me to get back and let me code everything today, but with the perfectly shitty way they've treated me, they fully expected me to quit and figured now was as good a time as any to start winging it.

So they got the Director of Nurses on the job. She knows a little something about codes and about PPS. Surely, she could handle it, in a pinch. Right?


She called in 2 women to help her. I assume they are coders from the hospital she used to work for until recently. Acute care coders, that is. Unfortunately, acute care coders can't quite do rehab reimbursement work. It's just too different.

They coded about 12 cases. I haven't looked at them all. The first one I looked at was a stroke patient that they had somehow coded as just plain debility with weakness. They missed the stroke, the dysphagia, the speech and cognitive deficits caused by the stroke. The category they chose is a much lower category for payment and they lost about 5 grand on that case. The billing has already been submitted and they will have to refile to get their proper payment. Oopsie!

The next one I picked up was a polyarthritis case that was wrongly entered as an osteoarthritis case. Hmmm.... sounds so very similar but yet the payment is oh so different! It cost them 500 bucks.

I looked at 5 of them today, and all 5 had big losses. On one case, they missed the neuropathy that drives payment up a couple thousand. One case was a debility due to pneumonia and arthritis and they coded it as a total knee replacement. This lady had a knee replacement 4 years ago and it was not a factor in her rehab care. The loss on that case was $5030.00. At least.

Needless to say, things are about to change at my hospital.

I called the billing lady and told her that I hoped she didn't actually send in those codes, because I had only looked at 2 cases and found about 6 grand in lost revenue. She calmly swallowed her tongue and tried to hold down her panic. She said she would talk to the owner and get back to me.

She called back in a few minutes to say "Go ahead and do your comparison, and fax all that in to us, ok Sweetie?"

You betcha, honeybunch.

But that's not how it's going to go. I am going to do a full audit, find all the lost buckaroos, and find the approximate number of lost dollars. It will be 20 or 30 thousand at the rate I'm going. Three days without me.

I plan to call to the more reasonable of the 2 owners and tell him the dollar amount that they lost in my 3 DAY ABSENCE. What will it be like if I'm gone for 3 weeks, or 3 months, or forever? He's not a stupid boy. (But his business partner is.) I am going to explain to him how it has been for me, working there, being treated the way I've been treated and explain to him that this is why I am returning to my consulting business.

I am going to express my total willingness to work with them as a consultant, under contract of course, and express my enthusiasm in making the recovery of all this lost money my first project as soon as the new contract is signed, sealed, and delivered.

In other words, they are going to have to pay my consulting fee in order to get these codes from me. The nicer owner will vote to pay up. The jackass may value his pride more than the 25 or 30 grand he could recapture with my help.

I win either way. If they pay me, I win because I'll get a nice boost of money plus I will explain to them in great detail and show them in black and white on paper how I got those codes and this will show them, finally, what I've been trying to tell them all along. The lady they trusted to do it is a very intelligent lady, but she is not a PPS specialist, so she failed miserably. I would make a lousy director of nurses. I'm not trained for that.

There is a reason why I make good money. It's called education and experience. They lost the gratitude somewhere along the way and started thinking of me as a slave instead of a consultant.

If the jackass gets his way and refuses to give me ANYTHING but a pink slip, I STILL WIN, because I will have the knowledge that his assholery cost him however much money this turns out to be.

It also helps that I got a phone call today from the people I audited last weekend and they want me to audit 2 more hospitals. One is a huge project. They want me to recode every chart they've had on every admission for the past year. That will keep me busy and well paid while I wait for my corporate job to become available.

So things have gotten dramatically better on the job front in one fell swoop.

Now here's the CRAZY part: I had a premonition dream of this happening, but I didn't recognize it as such because it was too bizarre. I dreamed that my gruff uptight administrator walked up on me while I was changing clothes and he grabbed each side of my pants to help me pull the pants up. He was literally "helping me cover my ass". After that dream, I couldn't make sense of it because he has been such an asshole to me and has not been helpful at all. But today I realized that by his action of sending me home for 3 days, he allowed the bad coding to take place and he set the whole thing in motion and inadvertently helped me "cover my ass" by setting up a perfect avenue for me to show the bosses what I really do for them.

My dreams are often premonitions.

I hurt my arm today and it's driving me crazy. I got a charlie horse in my arm and it has continued to hurt a lot since then. I need a massage...

Oh MyyyyyyyyyyyRaaaaaaaaaaaahhhhh

spring - fall

5 This comments thingy doesn't work now because I let my paid membership lapse.

Words to Live By - 2015-03-04

Sunshiney - 2015-02-10

New and Improved - 2015-01-30

The Deep - 2014-12-30

In Love - 2014-12-29

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