What I Do

"You miss all of the shots you don't take" - Wayne Gretzky (a quote given to me by my former boss about a year ago, which I then taped on my book):

I have one of those jobs where people get this glazed look in their eyes after I tell them what I do for a living.

I assist in the coordination of all of the Government audits that we receive at our healthcare facility.

What does this entail exactly?  Here’s the process:  We receive an audit, with anywhere from 1 – 400 accounts on it.  We read the audit letter carefully, identify what they are auditing for (either medical necessity inpatient stays, correct coding, drug related issues, etc.), identify the accounts, gather the information, retrieve any other information, and send it off (electronically, thank goodness).

Then we wait.  And wait.  And wait.  When we get the results, we determine how many were favorable (we keep our money), and how many were unfavorable (they take our money back).  We go through them and decide which ones are worth appealing (we can appeal anything that’s been denied).  Then we send them off again to a company we work with that handles our appeals.  They write the appeal and send it off.

And we wait.  And wait.  And wait.  Then we get the result from that letter – favorable or unfavorable.  Then we decide if we appeal to the next level.  Do you see a pattern here?  There are 5 levels of appeal.  From the time we receive the first audit request to the time it gets to the last level of appeal (if it goes that far) can take 3-4 years.  I am not joking.

So there is tons of waiting, tracking, follow up, reports, pouring over clinical documents, etc.

And that is what I do.  I am pleased to say that in my 4 years of working with this company, I have never missed any audit deadline.  It’s a lot of work, but it’s surprisingly low-stress, which is nice.

However, there has always been one portion of my job that I’ve been a little bit more interested in – coding.  I found myself really looking at the coding denials we were receiving more so than the others.  So last year, my former boss started sitting with me and teaching me how to code.  Mostly inpatient (that was her specialty) and some outpatient.  I really liked it.  I’m not sure why.  It’s kind of like detective work.  And you have to have great attention to detail.  For those of you that don’t understand coding, here’s a little breakdown:

When you go see the doctor or have a visit to the hospital, everything the doctor does with and/or to you ends up in your medical record.  Your physical exam, tests, diagnoses, procedures, etc.  Same thing at the hospital.  Everything is charted.  A coder than takes that chart (usually within a day or two of discharge), and reviews the history and physical, discharge summary, progress notes, labs, pathology reports, etc..  they then assign a code to every single procedure, diagnosis, secondary diagnosis, condition, etc.  There is a code for everything.  From something as simple as a basic immunization to open heart surgery.  

It’s not as easy as it sounds though.  There are rules.  Guidelines.  Sequencing issues.  Exclusions.  Certain codes cannot be paired together.  You can’t overcode and you can’t undercode.  You have to pay attention to body sites, suture lengths, unspecified conditions, acute conditions, chronic conditions, present on admission conditions, hospital acquired conditions, complications, comorbidities, v-codes, e-codes, etc.  I could go on and on and on.  You have to dissect the medical record to make sure everything is captured.

Once all of the codes are in place, the computer analyzes them (instantly) and assigns them as an MS-DRG (Diagnosis Related Group).  

Usually the DRG ends up being the principal diagnosis, but not always.  Each DRG is assigned a ‘weight’, and each weight is assigned a dollar amount.  The higher the weight, the higher the dollar amount.  The hospital is then reimbursed according to the DRG.  Sometimes it ends up being more than if each item were billed separately, sometimes it’s less.  When coding is complete, it gets sent to billing.  And from there, well, honestly I’m not sure what happens.  I’m not a biller.

So I was doing pretty good studying with my boss with the eventual goal of becoming a certified coder.  But then she left.  And I stopped studying.  And then I seen something on the AHIMA website (the organization that accredits inpatient coders) that stated that as of March 31^st, the CCA exam will be on ICD-10 coding (not ICD-9 coding).  I FREAKED out.  For real.  ICD-10 is a just a bear.  It is complicated.  I don’t know it.  And I had been studying (well kind of) for ICD-9.  There is no way I wanted to test in ICD-10.

So in a matter of eight days, I registered and paid for my exam, got authorized to take the test (you have to have some experience and be a member of AHIMA, which thankfully I already was), scheduled my exam, and took and passed it Thursday night.

 It was 8 days that felt like two months!

And honestly, the test was awful.  I was convinced that I failed.  I didn’t feel sure on probably 75% of the answers.  It was multiple choice, thank goodness, but there was a TON of coding on it and a two hour time limit.  Yes, I know it’s a coding exam.  But it also included a lot of Health Information Management stuff as well.  I’ve taken other certification tests in the past (Medical Assistant, General Insurance) and this was by far the hardest.  I was convinced I was going to run out of time.  Most of the actual coding questions were all at the beginning, which ate up a lot of my time.  At my 1 hour mark, I was only on question 39 (you have two hours to take a 100 question test).  I wanted to be on question 50 at that point!  But it all worked out, I even had 8 minutes to spare to review my answers.

So what does this all mean?  It means I have a certification now (CCA).  It will help with my current job (reviewing coding denials, possibly writing appeals myself).  It will open further doors for me if I decide to become a coder.  I will have to keep up my certification with a certain number of CEU’s each year (which I can get all at work thankfully).  My job will pay for my test since I passed and they will now pay my membership dues each year, which is nice.  

And....it's done!  I did it.  Here's the flowers my husband sent me on Friday at work:

It made my already great day even better!

Still Couponing

I'm taking a study break (more on that later....maybe), so I thought I would blog.

I'm still couponing!  Not 'extreme'-ly of course, but I rarely make a purchase these days without using a coupon.  

When I first started last year, I got all excited and bought a huge binder with baseball card divider holder things, I had a complicated Excel spreadsheet, the whole 9 yards.  I had the binder that the major extreme couponers use.  Why I felt I needed that is beyond me.  My system broke down almost immediately (shocking).  It took forever to update it, and most of the time my binder (and spreadsheet) were full of expired coupons and ones that were just loose and ripped because I just didn't have the time to keep up with that complicated system.

So then I went old school.  I took a small notebook and wrote down all of my coupons (by category) and expiration dates.  I then ditched my huge binder and found a small pouch (I had originally purchased it a long time ago to hold my iPad Mini, before I got a proper cover for it).  I am pleased to say that the small pouch is still working.  But the notebook is history.  It was just too time consuming to flip through pages, compare it to the Target ad (I am still pretty much exclusively couponing at Target), cross off expired offers, etc.

So I did some research and downloaded an app for my phone called 'Coupon Keeper':

It.  Is.  AMAZING!!!  

Here's how it works:  you still clip coupons just like normal.  Once they are clipped, you scan the barcode of the coupon with your smartphone.  The app will then keep track of all of your coupons for you, alert you when some are about to expire, allow you to sort them by type (grocery, pets, etc.), by store (it recognizes my beloved Target coupons), etc.  Once they expire, they drop off your list. 

You can also search by product.  For example, this week Target had Tide on sale paired with a gift card (buy any 3 certain Tide or Downey products, get a $10 Target gift card).  So I typed 'Tide' and then 'Downey' into the search box and found coupons that I could use with this offer:

I then pulled them from my pouch and put them in my wallet to take to the store with me.  Easy peesy!  Once I pulled them out, I marked them as 'used' in the app, so they will fall off my list of 'active' coupons.  The app will still track them though and let me know how much I'm saving:

I'm pretty sure this is the system that will stick.  The pouch is small enough to fit in my purse, but most of the time I just keep it in my car tucked under the drivers seat.  That way I always have my coupons with me and my purse isn't weighed down.  I'm loving the app so far too.

By the way...if you are a regular Target shopper, it really does pay off to coupon there.

During my trip on Tuesday, my total bill came to $116 (groceries mostly, some pet food, etc.).  After handing over my coupons AND scanning the barcode from the Target Cartwheel app (e-coupons), It brought my total down to $100.  The Target Cartwheel app is amazing.  Most of the offers on it are pretty low (5% off or 10% off), but every now and then an amazing deal will pop up.  This time it was Special K cereal.  50% off!!!!  And guess what?  I had a coupon too.  I got these two boxes of Special K for less than $1.50 each:

Thankfully, my husband is not picky about cereal and he has a bowl of it every morning for breakfast.  

During this transaction for $100, I received two Target gift cards to use for my next purchase.  One of them was for $10, which I got for buying three Tide and/or Downey products.  The next one was for $5, which was for buying 3 packages of Slim Fast, which I happen to drink every day for breakfast:

When you receive Target gift card offers during a transaction, you can't use them towards that same transaction.  So I couldn't have handed them over and brought my bill from $100 down to $85.  However, you can do two transactions and use them on the next one.

So, for my next transaction, I just had one item:

I paid $5 for it, after my gift cards and Target Red Card (5% off).

See?  It's like free money, people!!  Especially if the items you must buy are items you would use anyways (like laundry detergent and breakfast shakes).

Couponing at just one store is NOT difficult or time consuming.  I spend maybe one hour a week, and I save usually anywhere from $10 - $40 each time I go.  Definitely worth it in my opinion!

(ps, we haven't watched 'Frozen' yet.  Sadly, it is still sitting on our kitchen counter.  Maybe this weekend?)

Family Visit

Some of my family came to visit us in January (yes, I'm a little behind blogging about it, but I just got my pictures all sorted out).  My sister-in-law, my niece and my new nephew came.  It was soooo nice to see them!  The last time I saw them was in May of last year.  Well, except for my nephew….this was our first meeting. 

They arrived on a Thursday around lunchtime.  

We stopped for brunch at ‘The Egg and I’.  They make this fantastic egg dish called ‘The Wisconsin Scramble’ (eggs baked with lots of cheese – YUM)  Then we came home and they got settled.  My husband got home around 5:30 with pizza for dinner and flowers for my niece.  She loved them.

Friday, the four of us took the train to Santa Fe.  

We stopped for lunch at Tomasitas, which is right when you step off the train.  I got a veggie quesadilla, which was delicious!  Their sopapillas are the best I’ve had as well.

Then we caught the free shuttle that dropped us off in the Plaza, basically a giant square full of shops.  We ducked into a few of them, and found the toy store I was looking for:

http://www.moonrabbittoys.com/

(from Moon Rabbit website)

My niece picked out a stuffed puppy dog and I got a train set for my other nephew (that couldn’t make the trip).  It’s a cute little store.  Overpriced of course (it IS Santa Fe), but they have cute stuff.

Then we went to Dream Cakes Gourmet Cupcakes, which was conveniently located next to an ice cream shop.  Delicious! 

 (from the Dream Cakes website)

I got 'The Cookie Monster'.  It was delicious!

Saturday we went to breakfast (Weckfast!).  It was kind of busy, so my hubby and niece played Candy Crush as we waited for our table:

After breakfast, we went to the mall to take my niece to Build-A-Bear.  It was so fun and cute.  She picked out a puppy dog (of course).  She named her Leah.  The setup there is just so cute and interactive.  Every kid should do it once.

I told her she could pick out an outfit or a doghouse for her dog and she picked the doghouse.  Good choice.  

Then it was back home for dinner and a movie (Mud, which we didn’t finish because we were all about to fall asleep.

Sunday was our last full day.  We went to the zoo!  I had never been to the Albuquerque zoo.  It was nice…not too big, not too small.  

We were able to get through the whole thing in about two hours.  I only wish it had been summer…everything blooms in the summer and actually turns green, especially at the zoo because it is right next to the Rio Grande.  So it was pretty brown.  However, it was beautiful out…sunny and no jackets required!

After we left the zoo we went home for a bit and then drove up to the base of the mountains about 20 minutes before sunset.  You can see the whole city from up there and watching the sunset is beautiful.

It was so nice to have them with us for a few days.

My niece and our little dog Hannah just loved each other.  Hannah followed her everywhere:

The next morning, I dropped them off at the airport and then went to work.  Boy, that was a depressing day!!  I’m so glad we had that time together though.  I am blessed with a great family and the cutest niece and nephews out there. 

The West Wing

I realize I’m late jumping on the bandwagon, but I finally finished the entire series of The West Wing.  I have a few thoughts:

*I totally get what all of the hype was when it was airing (1999 – 2006).  The writing was phenomenal.  The characters were fantastically cast.  The dry humor was spot on.

*It was WAY too political for me.  Yes, (as my mother-in-law points out) it IS called ‘The West Wing’.  So yes, I knew it would be political.  However, I was hoping they would delve a little deeper into the personal lives of each character.  And they do, but it wasn’t until sometime in season 2 that I seen one of the character’s apartments. 

*My favorite character, hands down, was C.J. Cregg.  She was the White House Press Secretary and then the last couple of seasons (SPOILER ALERT), she was the White House Chief of Staff to President Bartlett (Martin Sheen).  I loved everything about her character.  I believe Allison Janney won a couple of well-deserved Emmy's for her role as Claudia Jean Cregg.

*My second favorite was President Bartlett himself.  And his personal assistant, Charlie (Dule Hill).  Lovely people.

*Sam Seaborn (Rob Lowe) was probably next on my list, although he left around Season 4 I think.  I’m discovering that I am kind of a Rob Lowe fan too, because I adore him on Parks & Rec.

Overall, I enjoyed the series.  Honestly though, I didn’t pay much attention to all of the political stuff.  It is on Netflix streaming if you’re interested, and it has an 8.8 rating on IMDB (which is very high).  We own the series on DVD as well, because my husband is a big fan and has seen the series a few times.  I think he loved that I was finally watching it and showed interest, ha ha.

Sandia Crest

This past Sunday, we took a drive.  We wanted to get out of the house for a bit after pretty much being inside for 4+ days.  We dug out our day trip book:

We decided to drive up to the Sandia Crest.  We've been to the top of the mountains before, but via the tram, which drops you off at the restaurant, which is not at the highest part of the mountain.

We found the road that you access on the east side of the mountains, and headed up.  Hannah came along as well.

The higher we got, the snowier it got.

We finally made it to the top!

Can you see downtown Albuquerque above?  Nope?  I can't either, ha ha.

The three of us from 10,600+ feet:

Hannah had fun.  She likes the snow and got to pee in it, so her afternoon was complete.

She was super tired on the way home though, but was fighting sleep....she didn't want to miss anything.

She finally couldn't keep awake any longer.

It was a nice to get out of the house for a couple hours and get some fresh (chilly) air.