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This is part three of the conditional logic discussion. And the last, I promise. At least as far as I can see in the future.
Consider various solutions for solving ongoing issues
We mentioned that we’d been running into this problem with clients on an ongoing basis. It’s caused us to think about, “What can we do? How can we help solve this problem?” because it’s draining a lot of resources from us. It’s causing many issues where it’s hard for clients to get what they need because they can’t articulate precisely what it is they need.
Of course, this is extremely important because, originally, this client was a billing company. They thought that the objective of doing some of this analysis was to save time for their managers. It was to automate some of the processes they felt they were doing manually and free up hours and hours and hours per month for these managers who’re doing all these things manually or cobbling them together in Excel each time every month.
Expect the unexpected
We’ve found that the more significant issue and the one they didn’t anticipate, and it wasn’t their primary motivation for doing this, actually is quality control. What’s happened is that they uncovered most of the operational problems. It turned out people weren’t doing what the billing company owners thought the managers were doing. To illustrate, either they could not do the type of work that they thought they were supposed to be done in Excel and so on, or it wasn’t being done correctly or did it differently every month.
It became evident in going through and forcing the organization to articulate these rules that they didn’t have many rules, or they were in people’s heads, they weren’t clear, they weren’t working correctly. There were all kinds of issues where we kept saying to the company’s owners, “Whoops! Hey, this one isn’t working either. It isn’t just that we’re automating something. It’s we’re creating something new from scratch that you thought you were doing, but it turns out you weren’t actually doing, or it was botched horribly.”
Create a standard course of action
We’re constantly trying to explain the concept of rules and trying to get them to articulate their own rules to implement them and actually make them happen and happen correctly, not just save time for the managers in doing that.
What do we do? Now that we’ve gone through this, “How did we get to the stage? How did I personally get good at “if-then” statements and “else-ifs” and “else”?” and so on, is there a course?
We started searching for what kind of resources are available to teach conditional logic. We googled the crap out of this thing. We looked for dependent logic courses, anything we could find. And it wasn’t easy to find anything. I would say that probably a half-hour of searching around left us completely unproductive. We had not found anything that we thought we’d be able to give to clients or prospective clients and say, “Have whoever is going to be generating rules or interfacing with us about your own organization’s rules take this course or review this subject or read this article.”
Upskill your teams
Everything we kept finding was about like, “How to do “if” statements in Excel?” A lot of times, it assumed that you understood the logic structures. All you needed to do was to write software code to implement the known logic. So a lot of courses were about, “Okay, how do you do this in Python? How do you do this and this in these different languages?” That’s not helping any of our clients because they’re not writing software.
The problem isn’t their ability to write a particular script. That’s the ability to understand the logic structure and how to frame, “Hey, here’s what we do,” or “Here’s what we need,” or “Here’s the kind of fuzzy rules that are in people’s heads. How do we make that into something concrete and explicit and accurate?”
After going back several times, the best thing is we did come up with a couple of things.
If you’re trying to do this yourself, or if you’re trying to provide some learning resources to managers or people in your organization on how to do this, we think this is incredibly valuable. Even if you’re not going to automate it, even if you’re going to have a set of rules in Microsoft Excel like a list, and this is what a lot of organizations do.
Add more effective rules
They have sort of a list of rules for clients like, “Client A: when you do this type of injection, you’ve got to make sure you bill this additional code for the drug that gets injected” or “Only to these payers, do you bill those two or only on certain days or in this location” or “Make sure you include the C-Arm when it’s in this location. Make sure to bill for that.”
There are all these rules that everybody has. Putting those even just into an Excel list, how do you make it so that people can all understand what the rules are without having somebody explain it to them such that they’re instead really hearing the verbal instruction and ignoring what’s in it writing? How do you put something in writing that everybody understands that the same way and without requiring additional education?
Use non-traditional educational resources
The best resources we’ve found so far. Here you go. The first is, oddly enough, an LSAT course. It’s on YouTube. LSAT is the Law Review whatever test to get into law school. This has nothing to do with the law. But the conditional logic module that they have is pretty good. It’s called Conditional Logic LSAT Logical Reasoning, and LSAT Lab does it.
You can find that on YouTube. It’s about a 24-minute course, and it’s pretty good. The best thing about it is that they help people understand sort of “if-then” statements. It doesn’t go to the next stage, the “else-if” and the following kind of “else” statements. There is some natural nuance between those differences. I don’t want to dive into it too much here because I’ll spend way too much time doing it.
Here’s the following resource that we found, which is also on YouTube. This one is called 5.2: If, Else If, Else Processing Tutorial, and it’s done by The Coding Train. It’s about 11 minutes long, and this one dives more into the “if,” “else if,” “else” structure.
I hope that those two courses combined will help people get the essential foundation for conditional logic and understand putting together these logic statements. As a result, your or their rules make sense or clear to everybody. They can follow them, everyone understands them, there’s no misinterpretation or other kinds of issues. Ultimately, we’re hoping that will help the whole world in terms of improving our medical billing.
There’s some hopefully really valuable stuff in there for you. We spent a lot of time trying to talk about money. Please share!