On 02/17/13 09:00 AM, Ken Dibble wrote:
From the report: "For example, many claims we reviewed were subjected
to the eMedNY edit "Medicare/MCO Payer Amounts Not Reasonable." However,
the edit was "set to pay" (as opposed to pend or deny) a questionable
claim. If this edit was set to pend or deny payment, eMedNY could have
prevented the aforementioned overpayment (totaling $6,171,957) when a
date was entered into the field designated for a copayment."
This certainly implies that the software had a user-configurable setting
for what happens when a questionable claim comes in. Let's ASSuME that's
true and not that the behavior was in fact hard-coded.
Why would such software be designed to automatically pay ANY invalid or
questionable claim without prompting a review by a human first? How is
that good design?
I think I'd tend to call that a failure of administration, rather than
design. There's an option (provided in the design and implementation)
to select the desired action when questionable input is detected. The
system manager/administrator failed to set it according to the desired
business rules. Not a 'design' problem, IMO, although I'm not sure I'd
EVER provide the option to 'ignore' the problem!
What IS a design problem, IMO, is displaying a date as digits only for
data entry. I might display '06/17/57' or '06/17/1957' (VFP is happy
with either one), but never without the slashes. Asking people to enter
a date into a box that says '06171957' is asking for trouble.
Dan
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