A CODER'S DREAM

Adapted By
Quinten (Quin) A. Buechner

There dwelt in the city of Washedbalt an auditor of great repute and his chief spake to him saying: "Lo, there is in the vast wilderness of the non-tidewater a physician's office group practice, and they have received money from the Medicare program. In fact, they have filed beaucoup claims, and great is the dollar value thereof for services which are claimed to be legitimate. Get thee hence and audit them. Take thy calculator, red pencil and other things, that thou mayest review them so that they be so bureaucratically correct the width of a certain part of a gnat may not slip through. For I say unto thee, if thou findest no faulty documentation or if the other Lords of the OIG or the High Lord of HCFA find you report and suggested fines wanting, then I will tear a strip off thee. Yea, if your investigation be not minutely done, then will I cause great misfortune to fall upon thee."

And the auditor, who was a stout-hearted bureaucrat, spake thus: "OK, Boss, that which is demanded of the Great Lords of H&HSD shall be done."

And then he departed and journeyed out of the tidewater, over the mighty APP Mountains to the practice site. There he opened his briefcase (displaying the forty-five and gold badge) and spake to the receptionist: "Let us hie ourselves thither to the file room that I may begin by reviewing charts. But the receptionist said: "Nay, Good Sir (using the term loosely), I must first call me the Practice Administrator and the Lawyer. Please be seated."

In the fullness of time did the Administrator and the Lawyer come forth. Said the Lawyer: "Dost thee have a warrant of search? If thou dost, thou must produce it." The auditor with an evil grin spake thus: "Of course, O Learned Don, 'tis here." Upon gazing on the writ the Administrator and the Lawyer counseled together. The Administrator then turneth and spake thus (with an even more evil grin): "Here's your closet, Charlie, the charts will be forthcoming. If you want a parking space, it'll cost ya'."

But the auditor chided him saying: "Before I review them, command thy manservants and thy handmaidens that they may also deliver unto me all the additional paperwork thereonto."

Then there were carried unto him three-hundred and forty nine scrolls, which were the waiver of liability forms, the physician enrollment forms, multitudinous 1500s, baskets of beneficiary assignment cards, stacks of applications for charity waivers and previous audit reports from the local carrier. Also there was brought unto him a dog license, a copy of the BBA, and a used hamburger wrapper, which were included amongst the other papers in error.

And they delivered unto him also many copies of appeals that the Carrier had ignored and transcripts of irrational conversations with Carrier's Customer Relations employees. There were also copies of the Compliance Program and DME authorizations and many other reports of strange and wonderful things of which no one knew any meaning.

And they brought forth a copy of the Medicare Carrier manual, Part 3 and a certification of training chart which was fifty cubits in length and a multitude of other things too numerous to recite.

For twelve days the auditor did look upon these things and on the twelfth day, he did say that they were good. Then he did review the statistical profiles and the reporting systems thereof and found them to be according to Hoyle.

And he put strange interpretations on the billing and documentation process and tested them upon the Laws of Perverted Logic. And he performed recoding upon them and recomputations of Allowables and some he recategorized.

Then he cast his eye upon them as through a microscope, a horoscope, a telescope, a periscope or a proctoscope (rigid). And he did project the billing and receivable system unto charts and gazed upon their form and it was fair. And he gauged everything by the LAW of IT-OUGHT-TO BE-SO and the LAW of INVOLUTED-BUREAUCRATIC-LOGIC. And, from the only part of the system, which seemed doubtful, he did cause a test case to be made. And great was the reliability thereof.

And the charts and the ledgers and printouts were fair to behold. Then he did cause the physicians to be cross-examined separately from the coders lest there be worms of fallacy in the system. These things and many others which are in the sacred books of the False Claims Act and Health Insurance Portability and Accountability Act did he perform with great cunning.

And when all these things had come to pass, it was the evening of the one hundred and twentieth day and he did make out a draft audit report and inscribed therein all the necessary details. And he did sign it and held an exit interview in which he did praise the system and documentation. Then he spake to the Practice Administrator saying: "I do declare that these claims and charts and posting system to have been done pretty darn good. I shall dispatch a final audit report of praise to the milady, the High Dame of the DOJ. If perchance, that report should bounce, then I shall catch and eat it without salt.

But lo, it came to pass that the report was rejected and a new audit was recommended, if and when the Lord's of the GPO can but find the warehouse of the manual revisions. For the audit had been conducted for the years of nineteen and ninety three to nineteen and ninety five but the Carrier Policy Manual and the MCM were dated nineteen and eighty five. And the grief of the auditor was terrible to behold.