Today wasn’t a very happy work day, but I’ve had worse. Tomorrow will undoubtedly be worse. I noticed just as I was getting ready to punch out that I had been assigned four RAs. Research Assists. That is when a pharmacy calls the Contact Center and the phone rep can’t answer their question. The phone rep fills out a Research Assist and it is assigned to someone who (theoretically) can answer and/or fix the issue. About 50% are very easy and take four or five minutes. About 25% are more involved, but still pretty easy and can be worked in about 10 or 15 minutes. The other 25% are nightmares sent from the bowels of Hades to torment innocent people who didn’t create the issue and will spend two hours on it and still won’t be able to fix it. Since I had ten minutes left of my day I opened the first one.
After about 30 seconds of reading the form I closed it. A claim had been denied for date of death. This is when the patient passed away but the pharmacy continued to bill after the date of death. Obviously, if Ms. Doe passed on May 20 Medicare isn’t going to continue to pay for oxygen for June. However, the date of death was entered incorrectly and Ms Doe was alive and well and using her oxygen. So the claim was re-processed to allow it to pay. BUT Ms. Doe was in the hospital in June, so the branch of Medicare that I work for doesn’t cover that. It has to be paid by Part A (hospitalization or skilled nursing facility, etc). So even though we tried to pay the claim, the computer system automatically denied it due to inpatient. The pharmacy insists Ms. Doe was NOT in the hospital and our records are wrong. So two weeks ago I re-adjusted the claim AGAIN to pay out. No dice. It denied a third time.
It makes me want to throw something. Hello, I do not work in system support. I don’t work in any department that can somehow over ride the system and force it to pay this claim. My job is to take the money back when a claim was paid in error. According to our computer records, the claim is denying properly.
I’m really looking forward to tomorrow. Sorry for the rant. :) I enjoy this tea. It is not an absolute favorite, but it is pleasant and mild, even soothing. I have about 15 grams of it left. I won’t have any trouble finishing it off, although I won’t buy it again.
Yikes. Well, good luck with that. Here’s hoping you can make it someone else’s problem. :)