The Medical Freedom Channel

This editorial has taken a while to write — not because the motivation wasn’t there (though that was certainly a minor factor), but because your esteemed editor was a bit concerned about the “security” issues involved.

You see, for the past two weeks (and expected to be well into the immediate future) yr. obt. sert. has been engaged in a full-time job, back in the conventional workplace for the first time in nearly a decade. Since his skill-set, though highly esteemed in some circles, is a bit harder to demonstrate out there in corporate meatspace, he’s taken on a data-entry/clerical position in order to get some bills paid.

However, even in only two weeks of observing and training, he’s repeatedly noticed a number of common errors committed, by those submitting official forms for processing. (Note: Further details of the place of employment are neither relevant nor properly disclosable; suffice to say it involves government paperwork servicing the healthcare industry.)

As a result of this newfound knowledge, he considers it only fair to pass along some tips on how to streamline the process of getting the desired effect from such transactions (assuming that desired end to be the efficient handling of the question, reimbursement or contract fulfillment involved). If your livelihood involves (even in a small part) communicating with a bureaucratic entity, be it governmental or corporate in nature, there are undoubtedly forms to fill out and mail, fax or otherwise transmit to some agency or office – one which probably has hired a staff of clerical workers and supervisors with the sole mandate of opening, sorting and directing each missive to its proper destination.

Assuming your intention is to get prompt responses, your best bet is to follow the often-convoluted set of instructions for filling out such forms … to the letter. Most folks do this fairly well, but they also often seem to forget how such a mass of paperwork is handled, even before it reaches the actual processing stage. The people who first handle your transmissions have specific rules to follow in opening and routing for processing, each day, several thousand individual envelopes. As a guide to getting your request processed more effectively, herewith, one of those “top ten” lists so popular on the late-night talkshows:

Top Ten Things (that I’ve noticed) that gum up the works:

1. What’s this thing about using extra staples? Do these folks have stock in Bostitch, or something? One is plenty to connect two (or even more) pieces of paper; you don’t need two right next to each other, or one in each corner of a smaller attachment, let alone scattered shards of metal all over the page! (Meanwhile, in attempting to dislodge each staple, so they don’t jam up the scanning system, each extra one makes it that much more likely the form might become torn, possibly leaving a ragged paper-edge that ends up gobbling the page instead of scanning it cleanly.)

2. While we’re talking staples, since when is the lower region (left or right) of a page a logical place to make the fastening(s), when the upper ones are so much more obvious and convenient? The middle of the page (along the edge) or the very bottom (left corner, parallel to bottom-edge) are both easily missed — even by the most scrupulous (and wide-awake?) clerical worker. Sometimes, conventionality is welcome.

3. Continuing with “connection issues,” why do some folks insist on taping pages together, instead of just using that single staple (or nothing)? The clerical worker then must (a) notice the pages stuck together, and (b) carefully cut between them, leaving no jagged edges on either side to clog the scanner. Yet another time/energy- waster, which over weeks and months may lead to less-attentive pre-processing.

4. An even larger issue: Why use the staples at all? A paper-clip serves the same purpose in multiple clumps of forms; in many cases the mere fact that a standardized form is followed by other pages of different sorts is enough; the clerical worker may or may not be your basic rocket-surgeon, but most of them/us are at least intelligent enough to recognize something that non-standard. If you stack the documents, and then fold them all in one batch, they should all arrive in proper order, and can be easily separated in the sorting process.

5. Which brings up the folding issues: Why do some folks insist on folding every single form, into three (sometimes four) sections, then piling that on top of five or six similarly folded ones, stacking them like cordwood. How much easier to lay everything out flat, then folding (or not, depending on envelope-size) the entire batch in one motion, before stuffing it all into the envelope? It takes maybe 3 seconds to unfold and flatten a whole batch of forms, with or without attachments, even from a fat envelope; it takes about 2 seconds to open up each folded single one – you do the math!

6. A similar faux pas that slows up processing is the one-form, one-envelope method. Some healthcare providers are seemingly convinced that each individual case is as likely to become lost in the mails as delivered properly; otherwise, how else do we explain the occurrences of a stack of 15-20 envelopes, all from the same return address, containing … with one sheet of form-paper in each envelope (each with its own postage-charge)? The waste of envelopes, postage and energy on both ends is considerable, and utterly unnecessary.

7. Then there’s the practice of sticking Post It Notes on top of each of several forms in a stack. If these are at all relevant to the case, they must be pulled off, and taped (on all four sides) onto a blank sheet of 8.5×11” paper, so they can be scanned with the rest of the forms. (If these are not considered relevant, they are often just discarded into the nearest trash-can, but it still takes time to read the note and determine its importance. (Note: Some providers have taken to affixing small labels, alerting the mail-sorter to the presence of attached claim-data, to the empty spaces on the form. This is sometimes useful, usually not, but at least it doesn’t push that form into a “special-sort” status, thereby delaying its processing.)

8. Finally, we come to a category I’ve dubbed “extraneous data,” which includes (so far) three basic forms of expression. The least obnoxious is the cover memo detailing the contents of the package with some identifier (e.g., patient names). It’s usually sufficient for the sorting person to glance at the list on the memo, compare it with the forms enclosed, discard the memo and file the forms in their proper stacks. However, this also adds a few extra seconds to each occurrence before the forms can get to their intended destinations.

9. Next up on the silly-attachments list is the “fax me back” request, listing the forms enclosed and then asking (often for each group of 3 or 4 in the envelope, then followed by 3 or 4 in the next envelope, with a similar coversheet and demand) that a sort of “return receipt” be tendered via the nearest fax-machine. With roughly 200,000 forms showing up in each day’s mail, how often do you think a mail-sorter has either the time or inclination to comply with such requests?

10. And finally, there’s the outright threat, or what I call the “appeal to authority,” which reads as follows (either by cover letter or attached sticker): “If this claim is not either granted or denied within ten days of receipt, a complaint will be filed with [insert appropriate nanny-state enforcement agency].” Ironically, since now this represents “correspondence” presumed to require a human response (and since it’s frankly rather offensive to the person opening that piece of mail), where do you suppose it will end up first? (Note: While the stickers usually get ignored, the actual cover-letter raises a red flag, and usually gets sidetracked, thereby thwarting the alleged purpose of the demand!)

Bottom Line: Unless your primary intention is to purposely mess up the process, as some sort of protest against the system (wrong target, folks! That clerical worker is not who you’re angry with!), avoiding these methods will make it far more likely that your form gets processed in a timely fashion.