A tongue-in-cheek take on our collective Risk Adjustment Dysfunctions
So we’re only a few days away. And I am not talking about Christmas! I am talking about the end of the year rush to get all of the 2014 DOS submitted to CMS before the big door is closed. Each year around this time, many payers and their providers go into a craze to get all the reviews completed in time for submission.Now that I think about it, Christmas is a good analogy to the CMS final sweeps. Each year, children count the days until the big man comes and leave presents under the tree and then they don’t have to behave for another 360 days. Each year, providers and insurance companies count the days until their coders and/or vendors provide that final RAPS submission to CMS and then they can relax for another few months.
I remember this vividly. So instead of droning away with how we can do this so much differently and more efficiently (we’ll tackle that next year – or call me if you can’t wait), let’s keep going with the Christmas motif, and wallow in the dysfunction that is January sweeps. So The Twelve Days Before Christmas become The Twelve Days before the Final Sweep. And here we go:
On the first day of final sweeps, my coders/vendors sent to me: a notice that they would not have all the charts coded prior to the Jan due date.
On the second day of final sweeps, my coders/vendors sent to me: 2 lame options to meet the deadline and a notice that they would not have all the charts coded prior to the due date.
On the third day of final sweeps, my coders/vendors sent to me: 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the fourth day of final sweeps, my coders/vendors sent to me: 4 TUMS to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the fifth day of final sweeps, my coders/vendors sent me: 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the sixth day of final sweeps, my coders/vendors sent me: 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the seventh day of final sweeps, my coders/vendors sent me: 7 coder resignations, 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the eighth day of final sweeps, my coders/vendors sent to me: 8 emails (I refused to read), 7 coder resignations, 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline and, a notice that they would not have all the charts coded prior to the due date.
On the ninth day of final sweeps, my coders/vendors sent to me: 9 not so nice words to describe the email I sent them the day before, 8 emails (I refused to read), 7 coder resignations, 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the tenth day of final sweeps, my coders/vendors sent to me: 10 shots of tequila, 9 not so nice words to describe the email I sent them, 8 emails (I refused to read), 7 coder resignations, 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline and, a notice that they would not have all the charts coded prior to the due date.
On the 11th day of final sweeps, my coders/vendors sent to me: 11 promises to complete as much as they could be adding extra staff and working overtime, 10 shots of tequila, 9 not so nice words to describe the email I sent them the day before, 8 emails (I refused to read), 7 coder resignations, 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
On the 12th day of final sweeps, my coders/vendors sent me: 12 ICD 10 I21.3 codes when they actually completed coding the charts, 11 promises to complete as much as they could be adding extra staff and working overtime, 10 shots of tequila, 9 not so nice words to describe the email I sent them the day before, 8 emails (I refused to read), 7 coder resignations , 6 Xanax pills to calm my nerves, 5 reasons why the deadline would be missed, 4 Tums to settle my stomach, 3 vendors’ names, 2 lame options to meet the deadline, and a notice that they would not have all the charts coded prior to the due date.
So there you have it.
I’m sure it’s not that bad for you and hopefully you got a chuckle out of it.
Happy Holidays – See you in 2016!
