Monthly Archives: April 2015

Sending Out a Search Party

If anyone finds the following book, let me know. I will pay a pretty penny for it. I can’t seem to track down a copy of this book for any price anywhere.

The Elliptical Grave, R.A. Lafferty


New Releases

Since I am unable to read fiction at the moment, see post below, (and it is freaking killing me!!!) I thought I would at least give a heads up on a couple of releases that I find noteworthy.

First up is John C. Wright’s new installment to his ‘Count to the Eschaton’ Sequence. It is the fourth book, so if you haven’t read any of them, this is not the place to start. I haven’t read it so I can’t specifically recommend it, but I can go on his excellent prior material and recommend this.


Next up is one I commented on in January, but it bares repeating. There is not even a review of it on Amazon yet! And that is the latest volume of Lafferty Short stories, The Man with the Aura.


I really, really really wish I could dig into this RIGHT NOW!

And last but not least is a sort of Lafferty Fanzine called Feast of Laughter, apparently they are on volume two. I will certainly be picking these two up. I can’t say that I recommend it (although two of the authors I know to be quite knowledgeable of all things Lafferty) because I just discovered it. But if you are a fan of Lafferty (and ya better be, friend) this should be at the least a curiosity. I’m certainly interested.

FOL 2 front cover

Medical Billing

So my “Secret Project” that I mentioned in passing in my Easter post is an online certification program I have been taking. I know, medical billing is a “chick’s” job, but I’ll be 45 here real soon and have been working on me feet since I was 14. And I have no skills outside a restaurant or bar.

Unfortunately I don’t believe I could have been talked into something more against the grain of not only my epistemology but human epistemology. I was talked into it by my wife. She used to do the job in the mid-90’s (she didn’t know you had to be certified, or was supposed to be) and a lot of it is work from home jobs nowadays. So she thought it would be cool it we both did this while she was unemployed. When she is employed now and I am stuck pursuing this most maddening of tasks by myself.

When I say against the grain of human epistemology – I mean just that. I have studied various things in my life, electronic engineering, trigonometry, music, philosophy, logic, theology (that’s a recent one, there). There is a structure to these disciplines (yes, even theology, lads) and they are taught in a structured manner. Medical coding and billing has no such structure. Half the crap you learn is the minuet of arbitrary government rules.

Get a load of some of this stuff – and note I haven’t read nor wrote a piece of fiction since I started this on February 15th – my soul (yes, laddies, there be those!) is rusting.

An example of a global prospective payment system is the Medicare system used to reimburse home health services: HHPPS, or home health prospective payment system. The Balanced Budget Act (BBA) of 1997, as amended by the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) of 1999, called for the development and implementation of a prospective payment system (PPS) for Medicare home health services. The BBA put in place the interim payment system (IPS) until the PPS could be implemented. Effective October 1, 2000, the home health PPS (HHPPS) replaced the IPS for all home health agencies (HHAs).


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

And this booger of a mind- melt

Ambulatory surgical center (ASC) system –The ASC is a freestanding outpatient facility that provides outpatient surgeries to patients. Previously the payment system consisted of an ASC list with procedure codes grouped into the different payment rates. Inpatient procedures were also shifted into the outpatient setting. This trend identified a need to change the ASC list to APCs. It took many years for this transition to become a reality, and finally in 2008, the final rule established that the components of the ASC PPS would be updated every year as part of the annual OPPS rule-making process CMS uses the ambulatory payment classifications (APCs) established in the hospital OPPS as the mechanism for grouping ASC procedures. The APC relative payment weights for hospitals become the basis for calculating ASC payment rates under the new payment system.


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

Translation? ASC used to be its own thing, but now it’s like APC.

And as an example of severe hierarchical inversion:

After acute care is finished, those patients that have serious long-term conditions may require extended stays. These patients may have multiple acute and chronic diseases and certainly can require complex care. Part A of Medicare provides services for this long-term care hospitalization for its beneficiaries. Services consist of 90-days in this setting. LTCH PPS was implemented in 2002. Many of these patients have chronic diseases such as cancer, tuberculosis, respiratory conditions and head trauma. Many of these patients are ventilator-dependent or require extensive rehabilitative services. Because these lengths-of-stay (LOS) are so much longer than an acute inpatient stay, there is a special reimbursement. The average LOS may be about 25 days or longer. The system is very similar to the MS-DRG system, but the calculations are different to account for this special circumstance. The PPS is based on MS-LTC-DRGs. They actually have the same groups as the MS-DRGs that are in effect for acute-care hospitals. The main difference is that the MS-LTC-DRGs have different relative weights and so therefore different payments.


Step, Career. ICD-9 Professional Medical Coding and Billing. Career Step, 09/2014. VitalBook file.

I had to look up both MS DRG and MS-LTC-DRG. Why? Because MS-DRG is not even a subject for another 20 pages!

And I do not know how many times I have had to click on a link (they provide them all over the text) and have to read an additional mind-numbing 20 pages on Medicare jargon!

And the acronyms! Mind you I still have three whole sections on biology and medical terminology and pharmacology to master. But there are about five to 10 new one every page and some of them are doozies. Try this one on.

IRF PAI – Inpatient Rehabilitation Facility Patient Assessment Instrument

I have a headache.

Kent, Shell and Other Things

So I moved out of tranquil Issaquah and moved to Kent because my wife got a job down here and Issaquah has been getting too damned expensive. When I say tranquil Issaquah, I mean I could take a nap anywhere in that city, in the open, at anytime of the day or night and not worry a bit about someone disturbing me. It is as close to Mayberry as you can get for safeness.

Basically the farther south you go the worse your neighborhood. There are pockets of good neighborhoods but the riff raff surrounds you on all sides. I begrudgingly moved down here. I’ve worked in the Kent/Renton area for some 17 years – it did not make me eager to live here as well. I suffered a two-hour round commute everyday for years to not live in it.

Sure enough, we are down here not even three weeks and about a hundred and fifty yards from my complex a one year old child is shot in the head in a case of road rage drive-by.

How so very… typical.


In other news Seattle protests Shell rig! Alright, not Seattle (although this is liberal weiny-ville so probably not too small a sample size) but some unshaven tree huggers.


I saw this on the news this morning and damn near spit up my orange juice in laughter. What do you suppose powers their boat? Since they didn’t arrive in a boat powered by the stroke of their oars, their only chance of consistency is to say that they don’t mind oil (or Shell) but let’s keep it in some stinking Third World country not our over-priced trendy little enclave of smug self-satisfaction.

Here is a question. How do so many people around here find the time to protest? It’s always during the middle of the week. Is this what you do when you are unemployed? Or, more likely, unemployable? I’ve never had the time for such frivolous activity. It’s called punching a time-clock!

Easter and Other Subjects


Long time, no post. I have been caught up in a secret project (unfortunately, nothing intriguing) and a move which still has me living out of boxes. I have no desk (yes, I still use such a thing) and I haven’t read any fiction in over a month. The last makes me a little cranky.

So I am at Target yesterday, Saturday, and I notice the parking lot is really full. It is a rather large lot and is not usually more than half full except for the Christmas season. My wife tells me it is the day before Easter and that is why the parking lot is near full.

Accounting even for those who make the twice a year exception and make their token call to church, there is no explaining that many people being at the store. There is simply not that many people, today, that take it seriously enough to account for such a full parking lot.

So, I think, many people celebrate Easter without any religious import. Further, many people celebrate Christmas in the same way, irreligiously.

Here is the difference: there is certainly something of a holiday to the non-religious on Christmas – indeed of the whole (mostly whole) season.

What is there of Easter for the non-religious? For the non-Christian specifically? Nothing. At most it is an obligatory time to get together with family for conventional reasons. And to color eggs (for some reason) and to hide them from children (for some reason) and to get candy (again, for some reason).

Unlike the “holiday season” there is nothing of import to Continue reading