Strange FISS-y People

You never really appreciate someone until they're gone. That's what all the wise men say, right? Well, I can say there's some truth to that, especially this week. You see, the reason there was no post yesterday is because Optimus Prime is on vacation with his house drama (which continues on, by the way) leaving me alone to tend the house. We had a big-to-do thing go down yesterday which left me completely swamped and lucky to squeeze in a bite to eat somewhere within the chaos. I would kill him when he comes back, but at some point, I'll get a vacation too, which is where the comeuppance will occur.

One thing I noted through all this is that some people out there can both know their job, and at that same time have no clue as to how it all works. You see, I deal a lot with something called the Fiscal Intermediary Shared System (or FISS, for short). It's also called the Florida Shared System and Direct Data Entry, but what it is in short is a method for hospitals to enter their claims directly into a system accessed by Fiscal Intermediary for Medicare (the government insurance program).

I know before I started doing this, I had no idea about any of this, so I imagine a lot of people don't really know about this whole behind the scenes stuff that goes on with how these Medicare claims are actually paid, and to be honest, there's no reason for most people to even care, but I would expect that someone whose job title includes "Medicare biller" would have at least a basic understanding of the process. You see, Medicare is a government entity that actually contracts out to another insurance company to pay their claims, which is where the term "Fiscal Intermediary" (or FI) comes from. Medicare pays nothing; it's usually an entity of Blue Cross/Blue Shield that does. Hence, if you are in Pennsylvania and on Medicare, your claim is actually paid by BC/BS of Western PA. In Oklahoma, it's paid by BC/BS of OK.

What I do is support the automation of the claim entry process into this FISS, so rather than a biller sitting at a terminal entering one claim at a time at however long that would take, we will zap in several hundred claims or more a minute through a process that simulates a biller sitting at this screen and entering information really, really fast.

This whole process is further complicated by how you get into this FISS. First, you need a special provider that can access this 3270 (old style DOS-like) connection. Then in most cases, there is a datacenter that provides the connection to the FI. Think of it like accessing your bank account online without owning a computer. Well, the easiest way to do this is via a library. Getting a library card is like getting the provider. The card allows you to access the library's computer system, which is like the datacenter. Then, once logged in there, you can login to your bank through their connection. And yeah, it's that complicated.

So, I caught a problem today. I noted that a login was not able to access the FI that it was supposed to be able to based on the claim info. So I give the person who handles it a call to let her know. I explain what is going on and she tells me they don't use BC/BS of Western PA. I explain the FI bit and go back to accessing through a specific datacenter, and she corrects me saying they go through X provider. I acknowledge this and continue to dumb down the explanation, leaving out more and more details of the process until we're at the root of the problem where she "gets" it.

The kicker here is that I talk to her a little later. She logs in, understands the application selection required in the midst of this, and understands the error I got and who to call. Me, I'm wondering how she can not get one piece at all and get the other. That's some limited understanding (and I apologize for the complicated nature of this post).

So last night, the Queen and I watched a fabuluos piece of American cinema: King Solomon's Mines from 1985 with Richard Chamberlain and Sharon Stone. This film was even better than its sequel, Allen Quartermain and The Lost City of Gold. Although based on novels, this film was every bit an Indiana Jones knockoff, right down to a lot of the scenes were lifted straight out of the first two Indy films, although the execution was far more ridiculous here. It was hard to take either of these films seriously. The dialogue was awful, the plot was silly, the exposition pedantic, the setups were blatant and ridiculous, the action unbelievable (and not in a good way) and the woman's only function seemed to be getting things explained to her. Perhaps the point was to be silly, but it seemed to be trying to be serious. I did love the mysterious disappearing ceiing in one scene though. And Sharon Stone was wearing the most fascinating shorts. As the movie progressed, they got shorter. Not torn, mind you (well until the end), but the hem was shrinking.

The Lost City of Gold was this way too, but even worse in so many ways. It involved the painfully typical plot of a guy who decides to blow off his wedding to go exploring. My personal favorite parts there were this "lost city of gold" was a city of white plaster where the streets are made of dirt sitting out in an open plain and populated by white people in togas. And should we mention the somehow directed lightning strikes that melted the golden dome? I mean, seriously.

Oh well. Some other movies I've seen recently were much, much better. Suspect Zero, for instance, was quite good. Cloverfield was really good. Spiderwick was meh. And I loved the episodes of Monty Python's Flying Circus.

Well, not a lot of time here, but it's better than nothing. Back to being swamped...