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My receptionist got out of the hospital Thursday so will hopefully be in Monday. She explained her Excel/Quickbooks/Amazing Charts system for recording incoming payments from insurance and patients, which predictably is a nightmare. My biller did the Excel, we are ignoring the Quickbooks, I saw the not-cancelled patients and worked on paper. The labs/xray reports/specialist notes/8 page plan of therapy from the physical therapist that I have to sign back/diabetic shoe request paperwork/note podiatry saying what I should order on the diabetic shoe order/refill requests/repeat refill requests/refill requests saying that if I hand SIGN a prescription I bloody well have to hand DATE it too/phone messages/requests to refer a patient for suboxone only the doc won't send me a note or referral letter or get prior authorization because hey, he'd have to put on paper that he thinks the patient has opioid overuse disorder.

My favorite WEIRDNESS this week was Triwest Veteran's Choice. They sent me a fax saying "You ain't sent us no notes on this patient, what is going down, you gotta fax notes all the time or you are breaking code B6942.EXCHTHULU.3 and we will fine you 1 billion dollars." Routine. But said patient went in the hospital for the 6th time in 6 weeks and died. I faxed Triwest Veteran's Choice the "discharge" summary saying he died. Heavenly discharge. Triwest Veteran's Choice faxed back that the patient was not in their system and that this had not been prior authorized.

By now I was tired, so I wrote on it that I didn't know a prior authorization was required before dying and faxed it back. I think they'd gotten the death announcement already, removed him from the system, and then couldn't remember that they'd requested something from me. Systems error.

We called patients on Thursday and cancelled half the visits, moving them back 2-4 weeks. I explained that with my receptionist out, my clinic was looking like a paper hoarder. At a certain point it all slows even more because with the scanning piling up, you can't FIND Mrs. Smith's labs. Half of clinic, the non-emergent, are cancelled Monday so we can keep catching up. Referral letters, there is another pile of normal labs and xrays where I have to send letters or SOMETHING. Every piece of paper has to be DECISIONED, initialled, dated, scanned, after scanning put in the in order date file for the follow up visit or mailed to the patient or specialist or with Triwest Veteran's Choice ALL THREE, something done with it.

Hope she'll be back Monday. Otherwise I need a temp and time to train them....aaaaauuuuuuggggghhhhh..... but we haven't had our big earthquake and tsunami yet. First world problems.