EONS AGO - THIS WAS THEN…
· Patient “Tommy” arrives.
· Patient signs in at reception desk.
· Chart is pulled by staff (or had been pulled the night before, ideally).
· Patient is asked if any of their demographic information has changed (if staff remembers to ask). New information that is collected is manually recorded in the patient chart.
· Co-pay collected, if due (and if staff remembers to ask). Co-pay is handwritten on a created paper log, if recorded at all.
· Doctor is running a half hour to an hour behind because two charts are missing and staff is in a frenzy to find them.
· Patient “Tommy” is finally called back by the nurse or medical assistant.
· Vitals, medical history and reason for visit are taken and hand recorded in Tommy’s chart by the nurse or medical assistant. Since there were no systems in place, there was nothing to compare vitals to from Tommy’s previous visit.
· Tommy tells the nurse that he’s there for a “cough”. Then, he waits again…and waits…and waits…
Meantime, out front again…with no real systems in place to keep track of patients within the work flow…
Patient “Sally” approaches the reception area… seems she has been sitting, waiting to be called for an hour…frustrated, late for work…
Oops…staff FORGOT about this one…
Back to Patient “Tommy”…
· Nurse escorts Tommy to exam room B, places chart in the chart slot outside of the door, enters the room to find Patient “Tina”, sitting on the exam table in her gown, waiting... and waiting… and waiting. Yet another OOOPS!
· Nurse finally finds an empty exam room where she asks Patient “Tommy” to once again WAIT…Doctor will be in “shortly” HaHa
At this point, the doctor is so confused, he’s/she’s uncertain which room to enter next, but finally, after opening three or four exam room doors, Dr. HardWorker locates “Tommy”, and the fun begins…
“Hi Tommy, what brings you in today?” I hear you have a “cough”? Doctor asks these questions while trying to simultaneously flip through the thick, overcrowded chart searching for allergies, past medical history, current medications and last visit date, two of which are found. This particular chart had been dropped by staff, is seriously out of order and the doctor cannot read their own handwriting on the last entry of the progress sheet.
“How long has this been going on?” The doctor continues.
Tommy replies, “Well, um, I don’t exactly have a cough. I didn’t want to say this to the nurse, so I told her I had a “cough” when in fact, I have this “embarrassing rash”
“Really, a rash? Tell me more”.
“Well, you know” says Tommy. “It’s a rash “down there”. “I’m itching like nobody’s business.”
“What have you tried to help this “rash”, says Doc?
“Some of that fungus or itch or…some type of cream, I’m not sure. That didn’t help, so then I tried some of that pink stuff, you know, for poison ivy. That didn’t help either. I had to wash that stuff off right away, my buddies at the gym got a real kick out of that one, imagine that. In fact, I think the pink made it worse because then I started getting these “bumps”, and now the bumps are oozing. Wanna see?
Doc says, yes Tommy, drop your pants and let’s have a look. By this time, Doctor HardWorker is running even further behind, and feeling a little impatient.
Tommy sheepishly drops his pants. Doctor steps back three feet, searching for gloves, and calls in the nurse.
“We need to take a swab” Doc says to the nurse. The nurse exits the room and Dr. HardWorker continues. He tells Tommy that he will need to send the swab out for testing, but that he will need to administer a shot of penicillin today.
“What do you think it is, Doc?”
“Looks to me like its Syphilis, answers the Doctor”. Doctor proceeds to go through the patient education routine, writes a prescription for the patient to take home, searches for and collects flyer's and leaflets on the disease for Tommy, and warns him that this disease is very contagious, and that he will need to let those he has been sexually active with know, including his wife”
The examination proceeds and the Doctor asks if everything else is going ok.
Tommy proceeds to tell the Doctor about his lower back pain, his athlete’s foot problems and his intermittent shortness of breath.
So….the visit continues….
After addressing Tommy’s additional symptoms and complaints, Doctor HardWorker decides that Tommy should see an Orthopedic Specialist for his back problems.
During the entire visit, Dr. HardWorker has been handwriting the progress notes, prescription, laboratory orders, follow up visit requirements and notes to the transcriptionist to write a referral letter to an Orthopedic Specialist.
Upon completion of Tommy’s examination and visit, the doctor exits the exam room to find his staff attending to personal business and explodes.
At the end of the long, grueling work day, after a laundry list of chaotic non systematic patient visits, an exhausted staff is working overtime to correct the day’s errors and an exhausted doctor has yet to return patient calls, review laboratory results, and sign off on progress notes. The doctor will get up and do the same thing all over again tomorrow.
Tommy’s chart ended up on the desk of the transcriptionist, awaiting a referral letter. The encounter form had been left inside of the chart, so the billing department did not receive the encounter to bill for the visit.
Three weeks later, when the transcriptionist finally gets to the chart, the encounter form was found and passed on to the billing staff. The biller inserts a HCFA form into their typewriter to manually type demographics, date of service, CPT Codes and when beginning the entry of the ICD-9 code, biller realized that handwritten information was illegible, and had to remove the unfinished HCFA form and return the chart to the doctors piles of other “to do” work” for verification and clarification of the visit.
Biller finally receives verification, inserts HCFA, again, completes the remaining mandatory fields on the form. Tears the two part form apart, files the “file copy”, folds the form, stuffs, addresses and applies postage to the envelope for mailing.
Six weeks later, the biller receives a returned claim at their desk. The claim had been denied as “Member not found”. A human error was made in the entry of the patient’s insurance ID number. Two of the numbers were transposed. The biller whites out the transposed insurance numbers, re-inserts the claim form into the typewriter and corrects the error. Manual copy of the corrected claim is made and attached to the original form after the chart has been re-located and pulled. The corrected claim is once again folded, stuffed, addressed and postage once again applied to the envelope for re-submission.
Yet ANOTHER six weeks later, the claim is returned once again. The biller is backlogged with follow up work as she has been covering the front desk due to staff turnover and another staff member on maternity leave. The claim was denied due to “Insurance Termed”. If staff had requested insurance changes at the time of the patients visit, the correct information would have been issued on the first submission of the claim. By this time, 15 weeks had passed since the date of the initial submission of the claim. An additional two months pass before the denied claim is re-addressed. The patient happens to be on vacation, and staff must wait for their return to obtain corrected insurance information. Two more weeks pass, and staff finally reaches the patient to obtain the new information, at which time the claim is re-typed, re-filed, re-mailed to the new insurance carrier. New insurance carrier receives the claim, and denies for “timely filing” because there is a time limit to file a claim within 6 months of the date of service. The biller does not want the doctor to know that she has not effectively done her job, so she destroys the paper trail of this claim and removes evidence from the patient ledger to prevent discovery of her errors. As the biller’s day continues, she attempts to keep up with the typing, filing, updating patient information, patient interaction, etc. etc. etc.
