Leading with a Go-Giver Mindset: How Collaboration and Mentorship Can Drive Success in Medical Practice Management
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor at MGMA and host of the MGMA Podcast Network. Welcome. We have another show today, and our guest is someone I've had the opportunity to meet over the years. And actually, I met her at a MGMA event when she told me she was a regular listener.
Daniel Williams:So I always love having people listen to the show and then join us. So we are joined today by Carol Ittig, and she is an MBA and has her FACMPE. A little bit more background about Carol. She's an administrator at Children's Orthopedic and Scoliosis Surgery Associates in St. Petersburg, Florida.
Daniel Williams:Carol, we're going to be talking a lot about leadership and a go giver philosophy. So first of all, before we do all that, I just want to welcome you to the show.
Carol Ittig:Oh, thanks, Daniel. I really appreciate being on the show, actually. And you're right. I am an avid listener. I have a thirty minute commute on the way to work, so I just have you in my queue, and I listen to you as your new episodes come out.
Carol Ittig:And I've actually even met people that you've had on your, podcast because they you know, the topic interested me. So I looked them up, and Dolores McNair is one of them, actually. I don't know if I told you that before.
Daniel Williams:No. I didn't know that, and that is so cool. It's kinda full circle, and so that is really, really neat. Well, thank you for joining us.
Carol Ittig:Of course. Thanks for having me.
Daniel Williams:And you and I got to meet in person, I think, for the first time. Was that in Denver at the leaders conference?
Carol Ittig:In Denver. I ended up getting stuck there because of the hurricane down here in Florida.
Daniel Williams:Oh my gosh. Had you been to Denver before?
Carol Ittig:I had been to Denver one other time. That's where I that's the year that I took my CMPE exam was in Denver. Oh. So, yeah, one other time.
Daniel Williams:Okay. Great. Well, you're in Saint Pete, and it's probably pretty warm there. We're in Denver, we've had snow recently. So we're kinda hunkering down for a very possibly cold winter.
Daniel Williams:So just
Carol Ittig:Well, I'm from Michigan, so I understand. And I am enjoying the 72 degree weather here in Florida.
Daniel Williams:Oh my goodness. All right. Well, it is so good to get to talk to you here in this setting. And one of the things I wanted to talk to you first about, you are an avid listener, so we do like to just do a little background with our guests. You're, I guess, a Michigan native.
Daniel Williams:Had mentioned you're now a transplant to Florida. Tell us a little bit about that healthcare journey. I'm always interested in what interests people in the first place. I will tell you, I was a biology major for my first year and a half of college because during that half I was taking organic chemistry with a tutor, could not pass it. Everybody failed one of the tests coming up, so the teacher gave it to us again.
Daniel Williams:It was a Saturday night. We were gonna have the test on Monday. I was studying, and I could hear all the music coming from all the parties on Saturday night around me. Still flunked the test, and I went, okay. I'm dropping the class and moved into kinda communications, journalism, all that good stuff.
Carol Ittig:Hey. It was the right thing to do, Daniel. You're doing great at it.
Daniel Williams:Couldn't get back organic chemistry, though. You being on the administrative side, I don't know that you had to take any of the biology courses. So where did your kind of interest in healthcare begin?
Carol Ittig:Actually, that's a great question because we just had our thirty year high school reunion actually. And one of the questions was, who was your favorite teacher in high school? That would have to be Mrs. Warner. She was a nurse and she had this medical skills class one and two, and at the end of that, you could do a co op and you could work somewhere and use your medical skills and you could take a CNA certification.
Carol Ittig:And my job that I chose was at a retirement home as a dietary aid. And I just really, really enjoyed talking to the retirees. I mean, I would go there every night after school. I would serve them dinner and they just became like a second family to the point where, you know, they would, they were like my, my grandparents. I had like a 100 of them.
Carol Ittig:And I thought, well, I really could do a career in like a nursing home as an administrator or something like that. I could just talk to these people all day. I just really, really enjoyed it. So when I went to college, I majored in healthcare administration and I was in a co op program. And as I was getting towards the end, I started doing little interviews with different people in the field.
Carol Ittig:And at that point in time, I was involved in an organization, I think it's called ACHE, which is for healthcare executives, hospital executives. And that was more on the track of what I thought I was doing. And as I was talking to one of those people, trying to get advice of what should my first job be out of school because I know I'm not going to walk into a nursing home and be an administrator, he said, well, you know you have to be licensed for that, and you have to have so many hours and this and that and the other thing, why don't you start in medical group management? I didn't even know what that was. So he kind of stepped me through that and my first job in healthcare was actually as a medical receptionist.
Carol Ittig:It's kind of a long story, but that's how I ended up in medical group management and just started and worked my way up from there. So, and I've enjoyed it. And the first job I had, somebody said, Hey, why don't you join MGMA? I And just don't do things like a little bit. I do them all the way.
Carol Ittig:So my first goal was to become certified and it evolved from there.
Daniel Williams:Yeah. We are so grateful you took that advice and you did jump in with both feet because you have just been integral since you've been a member. You've the fellowship and then you've been giving back. You're an avid listener to the podcast. You have played a huge role in our Community Live programs that we've had as well.
Daniel Williams:Tell us about that then. You said you don't do things halfway, but when you got into MGMA, was it just wanting to give back? Was it wanting to take advantage of everything available to you? What was it that you just keep reaching and moving forward with all these different programs and benefits that are out there available to you?
Carol Ittig:One of the things about being a practice administrator is you're kind of jack of all trades, master of some. And I find myself to be like one of those lifelong learners. I just really enjoy learning new things. So like, for example, this year, I dove into three new things in my job here that I've never done before. We started a research department.
Carol Ittig:We started a foundation called CHORTHO Cares that helps with pediatric orthopedic research. And we also started a real estate holding company because the doctors are buying the building that we occupy here in St. Petersburg. Those are all things I've never done before. And whenever I dive into something like that, I have to rely on my peers and my network.
Carol Ittig:And if I did not have that network of peers, either in the MGMA or AAOE, which is the other organization I belong to, I wouldn't be able to do my job today. I mentioned that I'm a Michigan native and I'm down here in Florida. I am down here in Florida because of my mentor, Debbie Mitchell. When I first joined another leadership organization for orthopedic executives, they asked me if I wanted a mentor. And I said, sure, why not?
Carol Ittig:I've been doing this for ten years, but never in orthopedic. So I have a lot to learn. So they assigned me to Debbie Mitchell. Debbie Mitchell changed my life. She was funny.
Carol Ittig:She was hilarious. I got to tell you when she called me to tell me that she was my mentor, she said, well, I'm going to take you all around Chicago to the best bars, and she's funny. She goes, and I'm gonna get you drunk, and we're gonna I'm gonna take you to dinner with all the best vendors, and you're gonna meet everybody. And she was true to her word. I participated willingly with all of the shenanigans, but we we became good friends and just kept in in contact.
Carol Ittig:And probably two years after that, I was planning a vacation to Florida and I thought, well, does Debbie live anywhere close to Sarasota? Because that's where I was going. And I called her up and I said, hey, Debbie, I'm gonna be in Florida. Can we do lunch? And she goes, well, yeah, but how about you interview for my job while you're down here?
Carol Ittig:I said, I'm not trying to move to Florida, Debbie. I'm just trying to have lunch with you. She goes, yeah, but I'm going to retire in eighteen months. I think you should have my job. And I don't know.
Carol Ittig:The rest is history. Once I met the doctors here and saw how giving they were and how they value their employees, I had never really had an employer like that before. And it was that way because of Debbie. And she taught me through her mentorship that boundaries are healthy. You don't have to allow behavior from people that isn't healthy.
Carol Ittig:And she didn't care if people liked her. She cared if she got the job done. And those are all things she, she taught me and to circle completely back to your original question, how did I get so involved in like the payer lives and stuff like that? Well, Debbie was great at revenue cycle management. I knew a little bit about it enough to, you know, manage a practice, but not the details that she knew.
Carol Ittig:And she really taught me everything she knew. And I gotta tell you, if I ever get out of administration, I'm gonna just do revenue cycle management because I love it. And it's it's just to me fun because you get to fight with the payers and eventually hopefully win. And but yeah, that's how I got so involved. It was because of her.
Carol Ittig:She was actually a listserv champion on the community listserv. She just was a giver too.
Daniel Williams:That segues into our next segment here in the conversation. You and I talked about a week or two ago, and we were talking about a book that influenced you and it's called The Go Giver. And I shared with you that in the MGMA Book Club, that was one of our selections in 2025. And so you and I decided we would chat a little bit about The Go Giver as well. So what is it about this particular book that's really resonated with you and has influenced how you are as a leader?
Carol Ittig:I picked up that book. We used to have date my husband and I used to have date nights way back when before kids, and we used to go to Barnes and Noble. And we would get a coffee and a treat and we would just shop around the store. I he's he's a professor in English education. So he has this love for reading and I have a love for learning, but not necessarily reading.
Carol Ittig:And so when I came by this book, I picked it up. It was very small, only 144 pages. And I thought I can do this. So I read the back and I was like, oh, wow, this is kind of like what I'm already doing. But I recognize myself on every page.
Carol Ittig:I had already been leading that way, giving value first, helping others without keeping score. And it just kind of gave me the language for my instinct. So I think my biggest principle that I align with in my style is giving without keeping score, but with boundaries, because being generous doesn't mean letting yourself get drained. It's giving in ways that empower people, not enable them. The go giver mindset is very important in health care because it's the second most regulated industry in the country, right behind nuclear energy.
Carol Ittig:It's impossible to self teach your way through it, and we need each other. Collaboration isn't optional. It's survival.
Daniel Williams:Yeah. I love that. Now you've told me offline that you just for this interview, you reread the book. Now it is short, and it's one of those if anybody hasn't read it, Carol and I highly recommend it here. But if you've read books like Who Moved My Cheese and other books like that, they're business leadership books, but they're set in would you call it parable form?
Carol Ittig:It's fable. A fable. Yeah. A fable. Yeah.
Carol Ittig:And those are the books I love. That's why I also love Get a Grip.
Daniel Williams:Okay.
Carol Ittig:That's another book I love.
Daniel Williams:Okay.
Carol Ittig:But yeah.
Daniel Williams:You just read it. I read it about six months ago, so jog my memory and anybody listening. The basic setup is just fill us in just basically. What's the basic
Carol Ittig:The basic plot line. Of the book, yeah, is the more you give, the more you get. And so there's five laws, the law of value, give more value than you take in payment, create values far beyond your job description, elevate every department you touch. The law of compensation, your income is determined by how many people you serve and how well you serve them. This is why I, you know, do pay your lives and I'm on the membership committee for a couple different organizations.
Carol Ittig:The law of influence, your influence is determined by how abundantly you place others interest first. So, you know, you you give your your team support and you help anybody that you can without them asking. You see they need help, you offer your help. Let them have the boundaries to tell you no, but offer. And then the law of authenticity, the most valuable gift you have is yourself.
Carol Ittig:You know, you you have to be authentic with what you're doing. If you don't love it, then you shouldn't try and do it. It's not gonna be authentic. And then the law of receptivity, the key to effective giving is staying open to receiving. So I can tell you, this is a very important principle because I had never really put too much thought into it, but I can tell you through the relationships I've made and this philosophy of mine that I have received back tenfold.
Carol Ittig:I'm involved in a couple of really cool projects right now that I would have never been involved with if I hadn't engaged in this, I guess, behavior. But you have to be open to receiving.
Daniel Williams:Yeah. It's so interesting that that's the one you zeroed in on because when we discussed it in the MGMA book club, that was one people honed in on. And I think we've all either been in this situation or we know people like this where when either you receive I'll use this as an example that was given in the book club. People that get a compliment and they deflect it. And it's sort of like negating the power of that compliment.
Daniel Williams:Like, Oh my gosh, I love that new outfit. Or, Oh my gosh, I love that you did that project and blah blah blah. And then it's immediately, well, thank you for recognizing that I made this effort to lose weight or I made this effort to go the extra mile on this project or whatever. But instead of saying that, you just go, oh, shucks, or you completely deflect it. Tell us how that resonates with you, that particular law or principle.
Carol Ittig:It resonates big time. Can think about I think way back in my career, first starting out, I worked with an awesome physician. His name was Doctor. Greg Naaman. His name is Doctor.
Carol Ittig:Greg Naaman. He's in Ferndale, Michigan. And I would always say, Oh, this practice administrator knows so much. She's so cool. And he would tell me, But Carol, you know just as much as her.
Carol Ittig:Stop putting yourself down like others are better. Or he would compliment me on like a blouse that I was wearing and I'd be like, oh yeah, but it's got stains on the wrist. Right. I can't get the stains out. And he'd be like, why did you tell me that?
Carol Ittig:I would have never known. Stop doing that. When you get compliments, just take them. Stop downplaying them. So I learned a lot from him actually too, as one of my mentors coming up through this career.
Daniel Williams:Yeah. You bring up something that we as you said, you've heard this show before. That's why I ask questions that they might go, gosh, is he going to ask the same question to every guest? And maybe at its core, it might be that, but then it branches out to wherever the conversation goes. But the thing that I really am interested in is that origin story and the impact others make in people's lives.
Daniel Williams:There's a lot of grit and self determination and resilience. But when I talk to people who are MGMA members, I don't recall talking to any or if at all very many people who didn't say someone else saw something in them and guided them. And I've already
Carol Ittig:That's right.
Daniel Williams:Yeah, from you talking, you already have Debbie Mitchell and then this second gentleman who also guided you and complimented you on your
Carol Ittig:Yeah, Doctor. Greg Neiman.
Daniel Williams:Yeah. Exactly.
Carol Ittig:That's exactly it.
Daniel Williams:Yeah. Talk about that because what we've seen and how you first came on my radar was people talking about your efforts in community live. We have paused that right now at MGMA just as we're reorganizing and doing things. But tell us about, Community Live and what that kind of networking in real time with your peers means to you.
Carol Ittig:It means everything because without each other, we have nothing. And I'll give you an example. And something that I'm doing outside of community life and probably what got everybody's attention is that I started a billing listserv for orthopedic billers. There are just some unique things that come up that are very niche to orthopedics that nobody else is gonna wanna listen to or read on a listserv. So I started my own listserv through this tool called Simple Lists.
Carol Ittig:And as things came up, I would throw out a question and hopefully somebody would answer and vice versa. If I could answer, I would. And one of the things that came up on that listserv was we were all getting the same denial on casting supplies. The denial was saying that casting supplies were inclusive in fracture treatment and that it was a new NCCI edit. And none of us, all of us were befuddled.
Carol Ittig:We're like, this is not a thing. I don't remember anything changing in NCCI. We checked all of the edits. There was nothing. And so, we started communicating.
Carol Ittig:Okay, now I'm getting it with Humana. Now I'm getting it with Aetna. Now I'm getting it with Cigna. And what we found out is that there is one company that serves 115 or 90% of the payers in the country on their claims editing software. And they had incorrectly interpreted an NCCI rule and implemented a rule to all of their payers that was incorrect.
Carol Ittig:And we would have never been able to figure that out had we not been talking. But my practice alone had 1,200 claim lines denied over like 50,000 worth of claims denied. And that was nationwide. Every single payer in the nation, including TRICARE, Humana was denying these claims that were actually payable. So I was able to work with AAOS, which is the orthopedic society for the physicians.
Carol Ittig:And they wrote a strongly worded letter to this third party vendor, letting them know that their edit was wrong. And they were able to turn the edit off and advise the payers that the edit was wrong. But then it was up to us providers to pursue with the payers to get paid because they did not proactively reprocess and pay those claims. So that's really how I got involved greatly with this payer live stuff because if we hadn't been communicating, that would have, you know, just persisted. And I've come to learn more about these payer audits.
Carol Ittig:There is AI going on, and we had talked about that last time we talked as well. And the AI is in the sense that there's a third party that's reviewing claims and suggesting audits for these payers to turn on. And they're even showing them how much money they'll save if they consider and turn on this edit. So while I don't know that there's really AI going on as far as diagnosis codes, because we know that there's E and M down coding going on right now too. We're trying to figure out the rhyme and reason to that or the pattern to that.
Carol Ittig:But the AI that I see is that there's that the payers are probably sharing edits or being suggested edits by their third party vendor, which is not good. In my opinion, probably is along the lines of antitrust.
Daniel Williams:In the remaining time, want to ask you a couple more questions.
Carol Ittig:We
Daniel Williams:just had a guest, Dr. Paula Ballester. You introduced the two of us. The three of us met, we talked a couple of weeks ago and were thinking about doing a show together, all three of us. And then I started talking to both of you and I went, No, y'all both have such incredible stories to tell.
Daniel Williams:I want to have y'all on separately. But the reason I bring that up is I just wanted to share yet again, that's you networking, that's you making connections in the industry. Tell us about anything you want to share about your relationship with Dr. Ballester and how y'all have benefited each other because y'all just had such a compelling story when I talked to you.
Carol Ittig:Yeah. So she's the director of utilization at our affiliated hospital, and I work with her on all types of things. Specifically, if we have a prior auth that is still pended at the time of surgery or we just come up with any roadblocks or bumps like in pediatrics. We have this issue with inpatient only procedures where peds, a lot of these fracture femur fractures can be done outpatient and adults. They always have to be inpatient because they require traction and things of that nature.
Carol Ittig:But for kids, they just remodel their bone and you don't have to do much. But there's always kind of issues with, they wanna change the place of service or because it's required for prior auth. It's kind of silly. But anyways, through that, I got to know her and I think she became very frustrated with this prior auth process and started talking about coming up with a software that would help providers with prior auth. Cause we know that the payers must be using.
Carol Ittig:So well, we know they're using something cause we saw the lawsuits against PXDX. I can't remember the other one, but they're they're basically looking at certain data to determine whether they're going to approve the prior author or not. So she took the idea of bumping up the payer policies against the documentation to see if there were any deficiencies. So once you make your authorization request, you are prepared. So it might say, okay, yeah, it looks like this patient is ready for you to submit prior auth except for like the payer requests for requires six weeks of physical therapy and six weeks of NSAID and you don't have documented.
Carol Ittig:Well, you know that the patient had physical therapy and you know that they told you that they took NSAIDs, but for some reason you didn't doc. So then you take the minute to go back and you find the physical therapy records and do an addendum to the note and record the NSAID usage, do an addendum to your note or a memo or or whatever it takes to make sure that it's properly documented. So when you do give your or do attempt your prior auth, it's all right there and then you don't give them a reason to deny. And then she also has a tool if you do get denied your prior auth, it can like comb through your information and give you kind of talking points for the peer to peer review. But that's how we really got involved.
Carol Ittig:And she also helped me with this one particular patient. We had over 90 emails going back and forth trying to get this patient authorized for an injection, a diagnostic injection in the IR department. And we could not get the payer to approve the injection until we ran the payer information and the documentation through her AI, which is HIPAA compliant. And it finally gave us all of the information we needed, which we had. We just didn't present it in the right way to get that procedure approved.
Carol Ittig:But that poor person was a gymnast and wasn't able to perform or compete because they were in pain. Those poor parents, all they wanted was for their child to be able to do what they love. And we couldn't get the prior auth approved even though they had benefits and they had all of the things required. We just weren't speaking the same language.
Daniel Williams:Right. I love you sharing that, and doctor Ballester briefly touched on that now as well. And I feel like it's that movie Rashomon. It's a Japanese movie where they tell the same story from different points of view. I'll have to have the patient on here as well now to to get the full story.
Daniel Williams:Yeah. That is
Carol Ittig:Or her parents. I mean,
Daniel Williams:they're her poor parents.
Carol Ittig:I mean, you know, a lot of the surgeries we do, you know, like a single event multi level surgery or like a spine surgery, These parents, they have their mom or dad or brother or sister fly in from out of town to help them with the recovery. Then to find out two days before the surgery that it didn't get authorized for some administrative issue is just devastating. These people take time off of work and make travel plans and arrangements. It's not good for patient care.
Daniel Williams:Well, I appreciate the work you're doing and the work that Dr. Ballester is doing as well. So last quick question here before we sign off. You are so integrated into MGMA. And when I talk to a lot of people at MGMA who are members, when I read the survey results, the information we get back, and we are very well aware that it's often difficult to find things on our website, how are you able to navigate?
Daniel Williams:How are you able to understand, Oh, right, here's the ACMPE or here's the fellowship program or here's Community Live or here's another committee or another volunteer opportunity? What secret sauce can you share with our listeners before we go to help them navigate all the things that are available at MGMA so they're not missing good stuff?
Carol Ittig:Well, I'm just going to flatter you with my response because I really don't have the time to read a bunch of emails and comb through the website. And so if I'm looking for something and I don't find it immediately, I I used to email the library and I haven't done that in a year or so. So hopefully that service is still available, but because I listened to your podcast every week, that's really how I'm learning all about the different things that MGMA has to offer. You know, I knew that there was a mentorship program, but I didn't know the depths of it until I heard the interview with Dolores. And and that really resonated with me because of my experience with my mentor.
Carol Ittig:But I think that I keep up to date by listening to you, Daniel.
Daniel Williams:Well, I did everyone, I did not plant that question to get that answer.
Carol Ittig:But that's that's true. It's true. And it makes it easy for me because I can just listen to you on the way to work or on the way home and I have the information I need.
Daniel Williams:Okay. Well, wonderful. Well, Carol Ittig, it has been such a pleasure to get to talk to you on the podcast.
Carol Ittig:Thank you. You too.
Daniel Williams:All right. Well, everyone listening, I want to wish y'all a happy holidays. And, we're going to put a lot of information in the episode show notes. We're also going to provide an article as well with a lot of resources in there. So until then, wishing you all happy holidays, and thank you all for being MGMA podcast listeners.
