Weighty problems....

Why is it that some issues don't weigh anything - and yet others weigh a whole bunch?  That is my question to you this morning.

Is it that the little things just don't bother us - and the big things do?  But what classifies as a 'big thing' and what classifies as a 'little thing'?

How would you classify these two issues.....

A co worker comes into work early and starts her online college homework.  She continues it throughout the day.  She is printing things like 'how to be a fashion designer' or 'how to run a Starbucks business' or any other thing she is looking at.  She is always whining she is behind in her work; she is always complaining she has too much to do and needs help.  Yet, come 4:30 she jumps up and is out of here.

I had asked a long time ago to get my hours changed to 7-4PM or even 7:30-4:30PM - and was told no.  Other people wanted to change their hours and they were told no.  But this person just does it and no one says a word to her.

Big issue or little issue?

Then there is this other co-worker.  Yesterday I overheard a phone call on a member that I had been involved with the original case.  I had done exactly as I was told, including moving the line item from my folder into another folder.  I know I did it.   Anyway, I overheard the call inquiring about the authorization.  I heard the person say there was no auth in the system.  Curious, I went to that person's file and no, there wasn't.  There should have been.

So I went to the coworker's completed folder to see where the fax was.  It wasn't there.  I checked another one.  Still no.  I went back to mine - and there it was in MY completed folder.  I'm pretty confident I didn't put it there, but I don't know of any other way it could have gotten there.

I pulled the fax and because we were on day 13 of a 14 day turnaround limit to be in compliance, I forwarded the fax to a coworker to 'shell' and send to a nurse to review, approve, and let's move on with it.  Well, our nurse who does these was out yesterday.  My coworker created the authorization based on the information on the fax, then notified our 'trainer' that it needed to be processed.  She was told to void the authorization, which she did.  The 'trainer' created a whole new auth, erroneously stating it was a phone auth request and ignoring the fax and what it was for, created the auth for something it wasn't.

Knowing that our guidelines state I am to call the member if beyond 10 days and send the authorization letter out via FED EX Overnight Priority, I went ahead and did that.  Although with the authorization being put in as a 'phone auth' gives us an additional 14 days and all I had to do was mail the letter regular mail.  I did what I knew I was supposed to do.  I corrected the letter to what it should be and faxed it to the provider.  I printed and sent to member.  I called the member.  I followed the rules for the original, true, request. 

Now my coworker and I are still in a turmoil this morning over this.  The authorization is still incorrect and it won't pay when the bill comes in.  The letter (which I copied before I changed it) contained incorrect information.  Was it done this way to keep from being 'dinged' by corporate?  I don't know.

I told my coworker this morning that I can't get it off my mind (and neither can she) so I have decided, since corporate is still auditing us daily, if they ask me why I called the member and sent out FED EX overnight priority when it was a phone auth, I will deal with the situation today.  If they miss it and do not catch all the erroneous information, I will wait until my friend and I go for our monthly walk in a week or so (she is the VP) and I will tell her what happened.  She needs to know about the situation.  She needs to know how it came about.  We were still in compliance at day 13; the auth could have been completed correctly.

Big issue or little issue?

So that is how my morning is going thus far; that is weighing on my mind.  I don't know which to hope for - the audit catching it or waiting until I can process all of it.  Still have not figured out how it got in to my completed folder.  Checked the history and it doesn't show anyone else touching it.  Or that I forwarded it.  It is really weird for there is no way it can be deleted or disappear.  I have no excuses; I don't know how it happened.  But we caught it in time.

So with all this - it's time to get to work.  I was able to get out at 6PM last night - nice.  Hoping I can get out early tonight as well.  I'm ready for the weekend.

Hope all your issues today are light ones!

Blessings!