In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams talks with Carol Ittig, MBA, FACMPE, Practice Administrator at Children’s Orthopedics and Scoliosis Surgery Associates in St. Petersburg, Florida. Carol shares her journey from healthcare administration student to influential leader, and how adopting a go-giver philosophy has shaped her approach to leadership, mentorship, and innovation.
Key Takeaways
- [03:35] Carol’s Path to Healthcare Leadership
Carol’s career pivot and how early experiences in patient care sparked her passion for health care leadership. - [07:35] Why Networking is Non-Negotiable
How leveraging MGMA and other professional networks enabled Carol to launch new initiatives like research programs and a foundation. - [07:49] The Power of Mentorship
Lessons from her mentor Debbie Mitchell — setting boundaries, embracing authenticity, and saying yes to growth opportunities. - [10:49] The Go-Giver Philosophy in Action
Carol explains the five laws from The Go-Giver and how they translate into leadership in medical practices. - [18:12] Solving Payer Challenges Through Collaboration
How Carol’s orthopedic billing listserv uncovered a nationwide claims denial issue — and the steps taken to resolve $50,000 in denied claims. - [21:07] AI and Prior Authorization: What Leaders Need to Know
Insights into emerging AI-driven payer edits and practical tips for navigating prior authorization hurdles. - [27:49] Navigating MGMA Resources Efficiently
Carol’s “secret sauce” for staying informed about MGMA programs without getting lost in the website.
Resources & Links Mentioned
- Carol Ittig on LinkedIn
- Orthopedic Executives Association (AOE)
- CHORTHO Cares Foundation
- The Go-Giver by Bob Burg and John David Mann
- MGMA Membership
- MGMA Mentor Program
- If you're interested in joining the MGMA Book Club, reach out to Daniel at dwilliams@mgma.org.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Daniel Williams (00:02):
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network.
Welcome. We have another showtoday, and our guest is someone
I've had the opportunity to meetover the years. And actually, I
met her at a MGMA event when shetold me she was a regular
listener.
(00:23):
So I always love having peoplelisten to the show and then join
us. So we are joined today byCarol Ittig, and she is an MBA
and has her FACMPE. A little bitmore background about Carol.
She's an administrator atChildren's Orthopedic and
Scoliosis Surgery Associates inSt. Petersburg, Florida.
(00:46):
Carol, we're going to be talkinga lot about leadership and a go
giver philosophy. So first ofall, before we do all that, I
just want to welcome you to theshow.
Carol Ittig (00:55):
Oh, thanks, Daniel. I really appreciate being on the
show, actually. And you'reright. I am an avid listener. I
have a thirty minute commute onthe way to work, so I just have
you in my queue, and I listen toyou as your new episodes come
out.
And I've actually even metpeople that you've had on your,
podcast because they you know,the topic interested me. So I
(01:17):
looked them up, and DoloresMcNair is one of them, actually.
I don't know if I told you thatbefore.
Daniel Williams (01:23):
No. I didn't know that, and that is so cool.
It's kinda full circle, and sothat is really, really neat.
Well, thank you for joining us.
Carol Ittig (01:33):
Of course. Thanks for having me.
Daniel Williams (01:35):
And you and I got to meet in person, I think,
for the first time. Was that inDenver at the leaders
conference?
Carol Ittig (01:41):
In Denver. I ended up getting stuck there because
of the hurricane down here inFlorida.
Daniel Williams (01:46):
Oh my gosh. Had you been to Denver before?
Carol Ittig (01:49):
I had been to Denver one other time. That's
where I that's the year that Itook my CMPE exam was in Denver.
Oh. So, yeah, one other time.
Daniel Williams (01:59):
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 kindahunkering down for a very
possibly cold winter.
So just
Carol Ittig (02:14):
Well, I'm from Michigan, so I understand. And I
am enjoying the 72 degreeweather here in Florida.
Daniel Williams (02:22):
Oh my goodness. All right. Well, it is so good
to get to talk to you here inthis setting. And one of the
things I wanted to talk to youfirst about, you are an avid
listener, so we do like to justdo a little background with our
guests. You're, I guess, aMichigan native.
Had mentioned you're now atransplant to Florida. Tell us a
(02:44):
little bit about that healthcarejourney. I'm always interested
in what interests people in thefirst place. I will tell you, I
was a biology major for my firstyear and a half of college
because during that half I wastaking organic chemistry with a
tutor, could not pass it.Everybody failed one of the
(03:08):
tests coming up, so the teachergave it to us again.
It was a Saturday night. We weregonna have the test on Monday. I
was studying, and I could hearall the music coming from all
the parties on Saturday nightaround me. Still flunked the
test, and I went, okay. I'mdropping the class and moved
into kinda communications,journalism, all that good stuff.
Carol Ittig (03:30):
Hey. It was the right thing to do, Daniel.
You're doing great at it.
Daniel Williams (03:35):
Couldn't get back organic chemistry, though.
You being on the administrativeside, I don't know that you had
to take any of the biologycourses. So where did your kind
of interest in healthcare begin?
Carol Ittig (03:48):
Actually, that's a great question because we just
had our thirty year high schoolreunion actually. And one of the
questions was, who was yourfavorite teacher in high school?
That would have to be Mrs.Warner. She was a nurse and she
had this medical skills classone and two, and at the end of
that, you could do a co op andyou could work somewhere and use
(04:11):
your medical skills and youcould take a CNA certification.
And my job that I chose was at aretirement home as a dietary
aid. And I just really, reallyenjoyed talking to the retirees.
I mean, I would go there everynight after school. I would
serve them dinner and they justbecame like a second family to
(04:35):
the point where, you know, theywould, they were like my, my
grandparents. I had like a 100of them.
And I thought, well, I reallycould do a career in like a
nursing home as an administratoror something like that. I could
just talk to these people allday. I just really, really
enjoyed it. So when I went tocollege, I majored in healthcare
(04:57):
administration and I was in a coop program. And as I was getting
towards the end, I started doinglittle interviews with different
people in the field.
And at that point in time, I wasinvolved in an organization, I
think it's called ACHE, which isfor healthcare executives,
(05:17):
hospital executives. And thatwas more on the track of what I
thought I was doing. And as Iwas talking to one of those
people, trying to get advice ofwhat should my first job be out
of school because I know I'm notgoing to walk into a nursing
home and be an administrator, hesaid, well, you know you have to
be licensed for that, and youhave to have so many hours and
(05:38):
this and that and the otherthing, why don't you start in
medical group management? Ididn't even know what that was.
So he kind of stepped me throughthat and my first job in
healthcare was actually as amedical receptionist.
It's kind of a long story, butthat's how I ended up in medical
group management and juststarted and worked my way up
from there. So, and I've enjoyedit. And the first job I had,
(06:03):
somebody said, Hey, why don'tyou join MGMA? I And just don't
do things like a little bit. Ido them all the way.
So my first goal was to becomecertified and it evolved from
there.
Daniel Williams (06:14):
Yeah. We are so grateful you took that advice
and you did jump in with bothfeet because you have just been
integral since you've been amember. You've the fellowship
and then you've been givingback. You're an avid listener to
the podcast. You have played ahuge role in our Community Live
(06:36):
programs that we've had as well.
Tell us about that then. Yousaid you don't do things
halfway, but when you got intoMGMA, was it just wanting to
give back? Was it wanting totake advantage of everything
available to you? What was itthat you just keep reaching and
moving forward with all thesedifferent programs and benefits
(06:58):
that are out there available toyou?
Carol Ittig (06:59):
One of the things about being a practice
administrator is you're kind ofjack of all trades, master of
some. And I find myself to belike one of those lifelong
learners. I just really enjoylearning new things. So like,
for example, this year, I doveinto three new things in my job
here that I've never donebefore. We started a research
(07:21):
department.
We started a foundation calledCHORTHO Cares that helps with
pediatric orthopedic research.And we also started a real
estate holding company becausethe doctors are buying the
building that we occupy here inSt. Petersburg. Those are all
(07:41):
things I've never done before.And whenever I dive into
something like that, I have torely on my peers and my network.
And if I did not have thatnetwork of peers, either in the
MGMA or AAOE, which is the otherorganization I belong to, I
wouldn't be able to do my jobtoday. I mentioned that I'm a
(08:02):
Michigan native and I'm downhere in Florida. I am down here
in Florida because of my mentor,Debbie Mitchell. When I first
joined another leadershiporganization for orthopedic
executives, they asked me if Iwanted a mentor. And I said,
sure, why not?
I've been doing this for tenyears, but never in orthopedic.
So I have a lot to learn. Sothey assigned me to Debbie
(08:25):
Mitchell. Debbie Mitchellchanged my life. She was funny.
She was hilarious. I got to tellyou when she called me to tell
me that she was my mentor, shesaid, well, I'm going to take
you all around Chicago to thebest bars, and she's funny. She
goes, and I'm gonna get youdrunk, and we're gonna I'm gonna
(08:45):
take you to dinner with all thebest vendors, and you're gonna
meet everybody. And she was trueto her word. I participated
willingly with all of theshenanigans, but we we became
good friends and just kept in incontact.
And probably two years afterthat, I was planning a vacation
to Florida and I thought, well,does Debbie live anywhere close
(09:07):
to Sarasota? Because that'swhere 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 whileyou're down here?
I said, I'm not trying to moveto Florida, Debbie. I'm just
trying to have lunch with you.She goes, yeah, but I'm going to
retire in eighteen months. Ithink you should have my job.
(09:27):
And I don't know.
The rest is history. Once I metthe doctors here and saw how
giving they were and how theyvalue their employees, I had
never really had an employerlike that before. And it was
that way because of Debbie. Andshe taught me through her
mentorship that boundaries arehealthy. You don't have to allow
(09:48):
behavior from people that isn'thealthy.
And she didn't care if peopleliked her. She cared if she got
the job done. And those are allthings she, she taught me and to
circle completely back to youroriginal question, how did I get
so involved in like the payerlives and stuff like that? Well,
Debbie was great at revenuecycle management. I knew a
(10:13):
little bit about it enough to,you know, manage a practice, but
not the details that she knew.
And she really taught meeverything she knew. And I gotta
tell you, if I ever get out ofadministration, I'm gonna just
do revenue cycle managementbecause I love it. And it's it's
just to me fun because you getto fight with the payers and
(10:37):
eventually hopefully win. Andbut yeah, that's how I got so
involved. It was because of her.
She was actually a listservchampion on the community
listserv. She just was a givertoo.
Daniel Williams (10:49):
That segues into our next segment here in
the conversation. You and Italked about a week or two ago,
and we were talking about a bookthat influenced you and it's
called The Go Giver. And Ishared with you that in the MGMA
(11:10):
Book Club, that was one of ourselections in 2025. And so you
and I decided we would chat alittle bit about The Go Giver as
well. So what is it about thisparticular book that's really
resonated with you and hasinfluenced how you are as a
leader?
Carol Ittig (11:28):
I picked up that book. We used to have date my
husband and I used to have datenights way back when before
kids, and we used to go toBarnes and Noble. And we would
get a coffee and a treat and wewould just shop around the
store. I he's he's a professorin English education. So he has
this love for reading and I havea love for learning, but not
(11:49):
necessarily reading.
And so when I came by this book,I picked it up. It was very
small, only 144 pages. And Ithought 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 Irecognize myself on every page.
I had already been leading thatway, giving value first, helping
others without keeping score.And it just kind of gave me the
(12:12):
language for my instinct. So Ithink my biggest principle that
I align with in my style isgiving without keeping score,
but with boundaries, becausebeing generous doesn't mean
letting yourself get drained.It's giving in ways that empower
people, not enable them. The gogiver mindset is very important
in health care because it's thesecond most regulated industry
(12:35):
in the country, right behindnuclear energy.
It's impossible to self teachyour way through it, and we need
each other. Collaboration isn'toptional. It's survival.
Daniel Williams (12:45):
Yeah. I love that. Now you've told me offline
that you just for thisinterview, you reread the book.
Now it is short, and it's one ofthose if anybody hasn't read it,
Carol and I highly recommend ithere. But if you've read books
like Who Moved My Cheese andother books like that, they're
(13:05):
business leadership books, butthey're set in would you call it
parable form?
Carol Ittig (13:11):
It's fable. A fable. Yeah. A fable. Yeah.
And those are the books I love.That's why I also love Get a
Grip.
Daniel Williams (13:18):
Okay.
Carol Ittig (13:19):
That's another book I love.
Daniel Williams (13:20):
Okay.
Carol Ittig (13:21):
But yeah.
Daniel Williams (13:23):
You just read it. I read it about six months
ago, so jog my memory andanybody listening. The basic
setup is just fill us in justbasically. What's the basic
Carol Ittig (13:34):
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 valuethan you take in payment, create
values far beyond your jobdescription, elevate every
department you touch. The law ofcompensation, your income is
determined by how many peopleyou serve and how well you serve
(13:56):
them. This is why I, you know,do pay your lives and I'm on the
membership committee for acouple different organizations.
The law of influence, yourinfluence is determined by how
abundantly you place othersinterest first. So, you know,
you you give your your teamsupport and you help anybody
(14:16):
that you can without themasking. You see they need help,
you offer your help. Let themhave the boundaries to tell you
no, but offer. And then the lawof authenticity, the most
valuable gift you have isyourself.
You know, you you have to beauthentic with what you're
doing. If you don't love it,then you shouldn't try and do
(14:37):
it. It's not gonna be authentic.And then the law of receptivity,
the key to effective giving isstaying open to receiving. So I
can tell you, this is a veryimportant principle because I
had never really put too muchthought into it, but I can tell
you through the relationshipsI've made and this philosophy of
(15:00):
mine that I have received backtenfold.
I'm involved in a couple ofreally cool projects right now
that I would have never beeninvolved with if I hadn't
engaged in this, I guess,behavior. But you have to be
open to receiving.
Daniel Williams (15:18):
Yeah. It's so interesting that that's the one
you zeroed in on because when wediscussed it in the MGMA book
club, that was one people honedin on. And I think we've all
either been in this situation orwe know people like this where
when either you receive I'll usethis as an example that was
given in the book club. Peoplethat get a compliment and they
(15:42):
deflect it. And it's sort oflike negating the power of that
compliment.
Like, Oh my gosh, I love thatnew outfit. Or, Oh my gosh, I
love that you did that projectand blah blah blah. And then
it's immediately, well, thankyou for recognizing that I made
this effort to lose weight or Imade this effort to go the extra
(16:03):
mile on this project orwhatever. But instead of saying
that, you just go, oh, shucks,or you completely deflect it.
Tell us how that resonates withyou, that particular law or
principle.
Carol Ittig (16:17):
It resonates big time. Can think about I think
way back in my career, firststarting out, I worked with an
awesome physician. His name wasDoctor. Greg Naaman. His name is
Doctor.
Greg Naaman. He's in Ferndale,Michigan. And I would always
say, Oh, this practiceadministrator knows so much.
She's so cool. And he would tellme, But Carol, you know just as
(16:39):
much as her.
Stop putting yourself down likeothers are better. Or he would
compliment me on like a blousethat I was wearing and I'd be
like, oh yeah, but it's gotstains on the wrist. Right. I
can't get the stains out. Andhe'd be like, why did you tell
me that?
I would have never known. Stopdoing that. When you get
compliments, just take them.Stop downplaying them. So I
(17:01):
learned a lot from him actuallytoo, as one of my mentors coming
up through this career.
Daniel Williams (17:07):
Yeah. You bring up something that we as you
said, you've heard this showbefore. 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 branchesout to wherever the conversation
goes. But the thing that Ireally am interested in is that
(17:31):
origin story and the impactothers make in people's lives.
There's a lot of grit and selfdetermination and resilience.
But when I talk to people whoare MGMA members, I don't recall
talking to any or if at all verymany people who didn't say
(17:53):
someone else saw something inthem and guided them. And I've
already
Carol Ittig (17:57):
That's right.
Daniel Williams (17:58):
Yeah, from you talking, you already have Debbie
Mitchell and then this secondgentleman who also guided you
and complimented you on your
Carol Ittig (18:07):
Yeah, Doctor. Greg Neiman.
Daniel Williams (18:08):
Yeah. Exactly.
Carol Ittig (18:10):
That's exactly it.
Daniel Williams (18:12):
Yeah. Talk about that because what we've
seen and how you first came onmy radar was people talking
about your efforts in communitylive. We have paused that right
now at MGMA just as we'rereorganizing and doing things.
But tell us about, CommunityLive and what that kind of
networking in real time withyour peers means to you.
Carol Ittig (18:35):
It means everything because without each other, we
have nothing. And I'll give youan example. And something that
I'm doing outside of communitylife and probably what got
everybody's attention is that Istarted a billing listserv for
orthopedic billers. There arejust some unique things that
come up that are very niche toorthopedics that nobody else is
(18:59):
gonna wanna listen to or read ona listserv. So I started my own
listserv through this toolcalled Simple Lists.
And as things came up, I wouldthrow out a question and
hopefully somebody would answerand vice versa. If I could
answer, I would. And one of thethings that came up on that
listserv was we were all gettingthe same denial on casting
(19:22):
supplies. The denial was sayingthat casting supplies were
inclusive in fracture treatmentand that it was a new NCCI edit.
And none of us, all of us werebefuddled.
We're like, this is not a thing.I don't remember anything
changing in NCCI. We checked allof the edits. There was nothing.
And so, we startedcommunicating.
(19:44):
Okay, now I'm getting it withHumana. Now I'm getting it with
Aetna. Now I'm getting it withCigna. And what we found out is
that there is one company thatserves 115 or 90% of the payers
in the country on their claimsediting software. And they had
incorrectly interpreted an NCCIrule and implemented a rule to
(20:10):
all of their payers that wasincorrect.
And we would have never beenable to figure that out had we
not been talking. But mypractice alone had 1,200 claim
lines denied over like 50,000worth of claims denied. And that
was nationwide. Every singlepayer in the nation, including
(20:31):
TRICARE, Humana was denyingthese claims that were actually
payable. So I was able to workwith AAOS, which is the
orthopedic society for thephysicians.
And they wrote a strongly wordedletter to this third party
vendor, letting them know thattheir edit was wrong. And they
(20:53):
were able to turn the edit offand advise the payers that the
edit was wrong. But then it wasup to us providers to pursue
with the payers to get paidbecause they did not proactively
reprocess and pay those claims.So that's really how I got
involved greatly with this payerlive stuff because if we hadn't
(21:17):
been communicating, that wouldhave, you know, just persisted.
And I've come to learn moreabout these payer audits.
There is AI going on, and we hadtalked about that last time we
talked as well. And the AI is inthe sense that there's a third
party that's reviewing claimsand suggesting audits for these
(21:42):
payers to turn on. And they'reeven showing them how much money
they'll save if they considerand turn on this edit. So while
I don't know that there's reallyAI going on as far as diagnosis
codes, because we know thatthere's E and M down coding
going on right now too. We'retrying to figure out the rhyme
and reason to that or thepattern to that.
(22:03):
But the AI that I see is thatthere's that the payers are
probably sharing edits or beingsuggested edits by their third
party vendor, which is not good.In my opinion, probably is along
the lines of antitrust.
Daniel Williams (22:22):
In the remaining time, want to ask you
a couple more questions.
Carol Ittig (22:25):
We
Daniel Williams (22:27):
just had a guest, Dr. Paula Ballester. You
introduced the two of us. Thethree of us met, we talked a
couple of weeks ago and werethinking about doing a show
together, all three of us. Andthen I started talking to both
of you and I went, No, y'allboth have such incredible
(22:47):
stories to tell.
I want to have y'all onseparately. But the reason I
bring that up is I just wantedto share yet again, that's you
networking, that's you makingconnections in the industry.
Tell us about anything you wantto share about your relationship
with Dr. Ballester and how y'allhave benefited each other
because y'all just had such acompelling story when I talked
(23:09):
to you.
Carol Ittig (23:10):
Yeah. So she's the director of utilization at our
affiliated hospital, and I workwith her on all types of things.
Specifically, if we have a priorauth that is still pended at the
time of surgery or we just comeup with any roadblocks or bumps
like in pediatrics. We have thisissue with inpatient only
(23:34):
procedures where peds, a lot ofthese fracture femur fractures
can be done outpatient andadults. They always have to be
inpatient because they requiretraction and things of that
nature.
But for kids, they just remodeltheir bone and you don't have to
do much. But there's always kindof issues with, they wanna
(23:56):
change the place of service orbecause it's required for prior
auth. It's kind of silly. Butanyways, through that, I got to
know her and I think she becamevery frustrated with this prior
auth process and started talkingabout coming up with a software
(24:17):
that would help providers withprior auth. Cause we know that
the payers must be using.
So well, we know they're usingsomething cause we saw the
lawsuits against PXDX. I can'tremember the other one, but
they're they're basicallylooking at certain data to
determine whether they're goingto approve the prior author or
not. So she took the idea ofbumping up the payer policies
(24:41):
against the documentation to seeif there were any deficiencies.
So once you make yourauthorization request, you are
prepared. So it might say, okay,yeah, it looks like this patient
is ready for you to submit priorauth except for like the payer
requests for requires six weeksof physical therapy and six
(25:03):
weeks of NSAID and you don'thave documented.
Well, you know that the patienthad physical therapy and you
know that they told you thatthey took NSAIDs, but for some
reason you didn't doc. So thenyou take the minute to go back
and you find the physicaltherapy records and do an
addendum to the note and recordthe NSAID usage, do an addendum
(25:23):
to your note or a memo or orwhatever it takes to make sure
that it's properly documented.So when you do give your or do
attempt your prior auth, it'sall right there and then you
don't give them a reason todeny. And then she also has a
tool if you do get denied yourprior auth, it can like comb
(25:43):
through your information andgive you kind of talking points
for the peer to peer review. Butthat's how we really got
involved.
And she also helped me with thisone particular patient. We had
over 90 emails going back andforth trying to get this patient
authorized for an injection, adiagnostic injection in the IR
(26:06):
department. And we could not getthe payer to approve the
injection until we ran the payerinformation and the
documentation through her AI,which is HIPAA compliant. And it
finally gave us all of theinformation we needed, which we
had. We just didn't present itin the right way to get that
procedure approved.
(26:27):
But that poor person wasa gymnast and wasn't able to
perform or compete because theywere in pain. Those poor
parents, all they wanted was fortheir child to be able to do
what they love. And we couldn'tget the prior auth approved even
though they had benefits andthey had all of the things
(26:49):
required. We just weren'tspeaking the same language.
Daniel Williams (26:52):
Right. I love you sharing that, and doctor
Ballester briefly touched onthat now as well. And I feel
like it's that movie Rashomon.It's a Japanese movie where they
tell the same story fromdifferent points of view. I'll
have to have the patient on hereas well now to to get the full
story.
Yeah. That is
Carol Ittig (27:12):
Or her parents. I mean,
Daniel Williams (27:13):
they're her poor parents.
Carol Ittig (27:15):
I mean, you know, a lot of the surgeries we do, you
know, like a single event multilevel surgery or like a spine
surgery, These parents, theyhave their mom or dad or brother
or sister fly in from out oftown to help them with the
recovery. Then to find out twodays before the surgery that it
didn't get authorized for someadministrative issue is just
(27:40):
devastating. These people taketime off of work and make travel
plans and arrangements. It's notgood for patient care.
Daniel Williams (27:49):
Well, I appreciate the work you're doing
and the work that Dr. Ballesteris doing as well. So last quick
question here before we signoff. You are so integrated into
MGMA. And when I talk to a lotof people at MGMA who are
members, when I read the surveyresults, the information we get
(28:10):
back, and we are very well awarethat it's often difficult to
find things on our website, howare you able to navigate?
How are you able to understand,Oh, right, here's the ACMPE or
here's the fellowship program orhere's Community Live or here's
another committee or anothervolunteer opportunity? What
(28:30):
secret sauce can you share withour listeners before we go to
help them navigate all thethings that are available at
MGMA so they're not missing goodstuff?
Carol Ittig (28:42):
Well, I'm just going to flatter you with my
response because I really don'thave the time to read a bunch of
emails and comb through thewebsite. And so if I'm looking
for something and I don't findit immediately, I I used to
email the library and I haven'tdone that in a year or so. So
hopefully that service is stillavailable, but because I
(29:02):
listened to your podcast everyweek, that's really how I'm
learning all about the differentthings that MGMA has to offer.
You know, I knew that there wasa mentorship program, but I
didn't know the depths of ituntil I heard the interview with
Dolores. And and that reallyresonated with me because of my
experience with my mentor.
(29:23):
But I think that I keep up todate by listening to you,
Daniel.
Daniel Williams (29:27):
Well, I did everyone, I did not plant that
question to get that answer.
Carol Ittig (29:32):
But that's that's true. It's true. And it makes it
easy for me because I can justlisten to you on the way to work
or on the way home and I havethe information I need.
Daniel Williams (29:45):
Okay. Well, wonderful. Well, Carol Ittig, it
has been such a pleasure to getto talk to you on the podcast.
Carol Ittig (29:52):
Thank you. You too.
Daniel Williams (29:54):
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 shownotes. We're also going to
provide an article as well witha lot of resources in there. So
until then, wishing you allhappy holidays, and thank you
all for being MGMA podcastlisteners.
Well, hi, everyone. I'm Daniel Williams,
senior editor at MGMA and hostof the MGMA Podcast Network.
Welcome. We have another showtoday, and our guest is someone
I've had the opportunity to meetover the years. And actually, I
met her at a MGMA event when shetold me she was a regular
listener.
(00:23):
So I always love having peoplelisten to the show and then join
us. So we are joined today byCarol Ittig, and she is an MBA
and has her FACMPE. A little bitmore background about Carol.
She's an administrator atChildren's Orthopedic and
Scoliosis Surgery Associates inSt. Petersburg, Florida.
(00:46):
Carol, we're going to be talkinga lot about leadership and a go
giver philosophy. So first ofall, before we do all that, I
just want to welcome you to theshow.
Carol Ittig (00:55):
Oh, thanks, Daniel. I really appreciate being on the
show, actually. And you'reright. I am an avid listener. I
have a thirty minute commute onthe way to work, so I just have
you in my queue, and I listen toyou as your new episodes come
out.
And I've actually even metpeople that you've had on your,
podcast because they you know,the topic interested me. So I
(01:17):
looked them up, and DoloresMcNair is one of them, actually.
I don't know if I told you thatbefore.
Daniel Williams (01:23):
No. I didn't know that, and that is so cool.
It's kinda full circle, and sothat is really, really neat.
Well, thank you for joining us.
Carol Ittig (01:33):
Of course. Thanks for having me.
Daniel Williams (01:35):
And you and I got to meet in person, I think,
for the first time. Was that inDenver at the leaders
conference?
Carol Ittig (01:41):
In Denver. I ended up getting stuck there because
of the hurricane down here inFlorida.
Daniel Williams (01:46):
Oh my gosh. Had you been to Denver before?
Carol Ittig (01:49):
I had been to Denver one other time. That's
where I that's the year that Itook my CMPE exam was in Denver.
Oh. So, yeah, one other time.
Daniel Williams (01:59):
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 kindahunkering down for a very
possibly cold winter.
So just
Carol Ittig (02:14):
Well, I'm from Michigan, so I understand. And I
am enjoying the 72 degreeweather here in Florida.
Daniel Williams (02:22):
Oh my goodness. All right. Well, it is so good
to get to talk to you here inthis setting. And one of the
things I wanted to talk to youfirst about, you are an avid
listener, so we do like to justdo a little background with our
guests. You're, I guess, aMichigan native.
Had mentioned you're now atransplant to Florida. Tell us a
(02:44):
little bit about that healthcarejourney. I'm always interested
in what interests people in thefirst place. I will tell you, I
was a biology major for my firstyear and a half of college
because during that half I wastaking organic chemistry with a
tutor, could not pass it.Everybody failed one of the
(03:08):
tests coming up, so the teachergave it to us again.
It was a Saturday night. We weregonna have the test on Monday. I
was studying, and I could hearall the music coming from all
the parties on Saturday nightaround me. Still flunked the
test, and I went, okay. I'mdropping the class and moved
into kinda communications,journalism, all that good stuff.
Carol Ittig (03:30):
Hey. It was the right thing to do, Daniel.
You're doing great at it.
Daniel Williams (03:35):
Couldn't get back organic chemistry, though.
You being on the administrativeside, I don't know that you had
to take any of the biologycourses. So where did your kind
of interest in healthcare begin?
Carol Ittig (03:48):
Actually, that's a great question because we just
had our thirty year high schoolreunion actually. And one of the
questions was, who was yourfavorite teacher in high school?
That would have to be Mrs.Warner. She was a nurse and she
had this medical skills classone and two, and at the end of
that, you could do a co op andyou could work somewhere and use
(04:11):
your medical skills and youcould take a CNA certification.
And my job that I chose was at aretirement home as a dietary
aid. And I just really, reallyenjoyed talking to the retirees.
I mean, I would go there everynight after school. I would
serve them dinner and they justbecame like a second family to
(04:35):
the point where, you know, theywould, they were like my, my
grandparents. I had like a 100of them.
And I thought, well, I reallycould do a career in like a
nursing home as an administratoror something like that. I could
just talk to these people allday. I just really, really
enjoyed it. So when I went tocollege, I majored in healthcare
(04:57):
administration and I was in a coop program. And as I was getting
towards the end, I started doinglittle interviews with different
people in the field.
And at that point in time, I wasinvolved in an organization, I
think it's called ACHE, which isfor healthcare executives,
(05:17):
hospital executives. And thatwas more on the track of what I
thought I was doing. And as Iwas talking to one of those
people, trying to get advice ofwhat should my first job be out
of school because I know I'm notgoing to walk into a nursing
home and be an administrator, hesaid, well, you know you have to
be licensed for that, and youhave to have so many hours and
(05:38):
this and that and the otherthing, why don't you start in
medical group management? Ididn't even know what that was.
So he kind of stepped me throughthat and my first job in
healthcare was actually as amedical receptionist.
It's kind of a long story, butthat's how I ended up in medical
group management and juststarted and worked my way up
from there. So, and I've enjoyedit. And the first job I had,
(06:03):
somebody said, Hey, why don'tyou join MGMA? I And just don't
do things like a little bit. Ido them all the way.
So my first goal was to becomecertified and it evolved from
there.
Daniel Williams (06:14):
Yeah. We are so grateful you took that advice
and you did jump in with bothfeet because you have just been
integral since you've been amember. You've the fellowship
and then you've been givingback. You're an avid listener to
the podcast. You have played ahuge role in our Community Live
(06:36):
programs that we've had as well.
Tell us about that then. Yousaid you don't do things
halfway, but when you got intoMGMA, was it just wanting to
give back? Was it wanting totake advantage of everything
available to you? What was itthat you just keep reaching and
moving forward with all thesedifferent programs and benefits
(06:58):
that are out there available toyou?
Carol Ittig (06:59):
One of the things about being a practice
administrator is you're kind ofjack of all trades, master of
some. And I find myself to belike one of those lifelong
learners. I just really enjoylearning new things. So like,
for example, this year, I doveinto three new things in my job
here that I've never donebefore. We started a research
(07:21):
department.
We started a foundation calledCHORTHO Cares that helps with
pediatric orthopedic research.And we also started a real
estate holding company becausethe doctors are buying the
building that we occupy here inSt. Petersburg. Those are all
(07:41):
things I've never done before.And whenever I dive into
something like that, I have torely on my peers and my network.
And if I did not have thatnetwork of peers, either in the
MGMA or AAOE, which is the otherorganization I belong to, I
wouldn't be able to do my jobtoday. I mentioned that I'm a
(08:02):
Michigan native and I'm downhere in Florida. I am down here
in Florida because of my mentor,Debbie Mitchell. When I first
joined another leadershiporganization for orthopedic
executives, they asked me if Iwanted a mentor. And I said,
sure, why not?
I've been doing this for tenyears, but never in orthopedic.
So I have a lot to learn. Sothey assigned me to Debbie
(08:25):
Mitchell. Debbie Mitchellchanged my life. She was funny.
She was hilarious. I got to tellyou when she called me to tell
me that she was my mentor, shesaid, well, I'm going to take
you all around Chicago to thebest bars, and she's funny. She
goes, and I'm gonna get youdrunk, and we're gonna I'm gonna
(08:45):
take you to dinner with all thebest vendors, and you're gonna
meet everybody. And she was trueto her word. I participated
willingly with all of theshenanigans, but we we became
good friends and just kept in incontact.
And probably two years afterthat, I was planning a vacation
to Florida and I thought, well,does Debbie live anywhere close
(09:07):
to Sarasota? Because that'swhere 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 whileyou're down here?
I said, I'm not trying to moveto Florida, Debbie. I'm just
trying to have lunch with you.She goes, yeah, but I'm going to
retire in eighteen months. Ithink you should have my job.
(09:27):
And I don't know.
The rest is history. Once I metthe doctors here and saw how
giving they were and how theyvalue their employees, I had
never really had an employerlike that before. And it was
that way because of Debbie. Andshe taught me through her
mentorship that boundaries arehealthy. You don't have to allow
(09:48):
behavior from people that isn'thealthy.
And she didn't care if peopleliked her. She cared if she got
the job done. And those are allthings she, she taught me and to
circle completely back to youroriginal question, how did I get
so involved in like the payerlives and stuff like that? Well,
Debbie was great at revenuecycle management. I knew a
(10:13):
little bit about it enough to,you know, manage a practice, but
not the details that she knew.
And she really taught meeverything she knew. And I gotta
tell you, if I ever get out ofadministration, I'm gonna just
do revenue cycle managementbecause I love it. And it's it's
just to me fun because you getto fight with the payers and
(10:37):
eventually hopefully win. Andbut yeah, that's how I got so
involved. It was because of her.
She was actually a listservchampion on the community
listserv. She just was a givertoo.
Daniel Williams (10:49):
That segues into our next segment here in
the conversation. You and Italked about a week or two ago,
and we were talking about a bookthat influenced you and it's
called The Go Giver. And Ishared with you that in the MGMA
(11:10):
Book Club, that was one of ourselections in 2025. And so you
and I decided we would chat alittle bit about The Go Giver as
well. So what is it about thisparticular book that's really
resonated with you and hasinfluenced how you are as a
leader?
Carol Ittig (11:28):
I picked up that book. We used to have date my
husband and I used to have datenights way back when before
kids, and we used to go toBarnes and Noble. And we would
get a coffee and a treat and wewould just shop around the
store. I he's he's a professorin English education. So he has
this love for reading and I havea love for learning, but not
(11:49):
necessarily reading.
And so when I came by this book,I picked it up. It was very
small, only 144 pages. And Ithought 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 Irecognize myself on every page.
I had already been leading thatway, giving value first, helping
others without keeping score.And it just kind of gave me the
(12:12):
language for my instinct. So Ithink my biggest principle that
I align with in my style isgiving without keeping score,
but with boundaries, becausebeing generous doesn't mean
letting yourself get drained.It's giving in ways that empower
people, not enable them. The gogiver mindset is very important
in health care because it's thesecond most regulated industry
(12:35):
in the country, right behindnuclear energy.
It's impossible to self teachyour way through it, and we need
each other. Collaboration isn'toptional. It's survival.
Daniel Williams (12:45):
Yeah. I love that. Now you've told me offline
that you just for thisinterview, you reread the book.
Now it is short, and it's one ofthose if anybody hasn't read it,
Carol and I highly recommend ithere. But if you've read books
like Who Moved My Cheese andother books like that, they're
(13:05):
business leadership books, butthey're set in would you call it
parable form?
Carol Ittig (13:11):
It's fable. A fable. Yeah. A fable. Yeah.
And those are the books I love.That's why I also love Get a
Grip.
Daniel Williams (13:18):
Okay.
Carol Ittig (13:19):
That's another book I love.
Daniel Williams (13:20):
Okay.
Carol Ittig (13:21):
But yeah.
Daniel Williams (13:23):
You just read it. I read it about six months
ago, so jog my memory andanybody listening. The basic
setup is just fill us in justbasically. What's the basic
Carol Ittig (13:34):
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 valuethan you take in payment, create
values far beyond your jobdescription, elevate every
department you touch. The law ofcompensation, your income is
determined by how many peopleyou serve and how well you serve
(13:56):
them. This is why I, you know,do pay your lives and I'm on the
membership committee for acouple different organizations.
The law of influence, yourinfluence is determined by how
abundantly you place othersinterest first. So, you know,
you you give your your teamsupport and you help anybody
(14:16):
that you can without themasking. You see they need help,
you offer your help. Let themhave the boundaries to tell you
no, but offer. And then the lawof authenticity, the most
valuable gift you have isyourself.
You know, you you have to beauthentic with what you're
doing. If you don't love it,then you shouldn't try and do
(14:37):
it. It's not gonna be authentic.And then the law of receptivity,
the key to effective giving isstaying open to receiving. So I
can tell you, this is a veryimportant principle because I
had never really put too muchthought into it, but I can tell
you through the relationshipsI've made and this philosophy of
(15:00):
mine that I have received backtenfold.
I'm involved in a couple ofreally cool projects right now
that I would have never beeninvolved with if I hadn't
engaged in this, I guess,behavior. But you have to be
open to receiving.
Daniel Williams (15:18):
Yeah. It's so interesting that that's the one
you zeroed in on because when wediscussed it in the MGMA book
club, that was one people honedin on. And I think we've all
either been in this situation orwe know people like this where
when either you receive I'll usethis as an example that was
given in the book club. Peoplethat get a compliment and they
(15:42):
deflect it. And it's sort oflike negating the power of that
compliment.
Like, Oh my gosh, I love thatnew outfit. Or, Oh my gosh, I
love that you did that projectand blah blah blah. And then
it's immediately, well, thankyou for recognizing that I made
this effort to lose weight or Imade this effort to go the extra
(16:03):
mile on this project orwhatever. But instead of saying
that, you just go, oh, shucks,or you completely deflect it.
Tell us how that resonates withyou, that particular law or
principle.
Carol Ittig (16:17):
It resonates big time. Can think about I think
way back in my career, firststarting out, I worked with an
awesome physician. His name wasDoctor. Greg Naaman. His name is
Doctor.
Greg Naaman. He's in Ferndale,Michigan. And I would always
say, Oh, this practiceadministrator knows so much.
She's so cool. And he would tellme, But Carol, you know just as
(16:39):
much as her.
Stop putting yourself down likeothers are better. Or he would
compliment me on like a blousethat I was wearing and I'd be
like, oh yeah, but it's gotstains on the wrist. Right. I
can't get the stains out. Andhe'd be like, why did you tell
me that?
I would have never known. Stopdoing that. When you get
compliments, just take them.Stop downplaying them. So I
(17:01):
learned a lot from him actuallytoo, as one of my mentors coming
up through this career.
Daniel Williams (17:07):
Yeah. You bring up something that we as you
said, you've heard this showbefore. 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 branchesout to wherever the conversation
goes. But the thing that Ireally am interested in is that
(17:31):
origin story and the impactothers make in people's lives.
There's a lot of grit and selfdetermination and resilience.
But when I talk to people whoare MGMA members, I don't recall
talking to any or if at all verymany people who didn't say
(17:53):
someone else saw something inthem and guided them. And I've
already
Carol Ittig (17:57):
That's right.
Daniel Williams (17:58):
Yeah, from you talking, you already have Debbie
Mitchell and then this secondgentleman who also guided you
and complimented you on your
Carol Ittig (18:07):
Yeah, Doctor. Greg Neiman.
Daniel Williams (18:08):
Yeah. Exactly.
Carol Ittig (18:10):
That's exactly it.
Daniel Williams (18:12):
Yeah. Talk about that because what we've
seen and how you first came onmy radar was people talking
about your efforts in communitylive. We have paused that right
now at MGMA just as we'rereorganizing and doing things.
But tell us about, CommunityLive and what that kind of
networking in real time withyour peers means to you.
Carol Ittig (18:35):
It means everything because without each other, we
have nothing. And I'll give youan example. And something that
I'm doing outside of communitylife and probably what got
everybody's attention is that Istarted a billing listserv for
orthopedic billers. There arejust some unique things that
come up that are very niche toorthopedics that nobody else is
(18:59):
gonna wanna listen to or read ona listserv. So I started my own
listserv through this toolcalled Simple Lists.
And as things came up, I wouldthrow out a question and
hopefully somebody would answerand vice versa. If I could
answer, I would. And one of thethings that came up on that
listserv was we were all gettingthe same denial on casting
(19:22):
supplies. The denial was sayingthat casting supplies were
inclusive in fracture treatmentand that it was a new NCCI edit.
And none of us, all of us werebefuddled.
We're like, this is not a thing.I don't remember anything
changing in NCCI. We checked allof the edits. There was nothing.
And so, we startedcommunicating.
(19:44):
Okay, now I'm getting it withHumana. Now I'm getting it with
Aetna. Now I'm getting it withCigna. And what we found out is
that there is one company thatserves 115 or 90% of the payers
in the country on their claimsediting software. And they had
incorrectly interpreted an NCCIrule and implemented a rule to
(20:10):
all of their payers that wasincorrect.
And we would have never beenable to figure that out had we
not been talking. But mypractice alone had 1,200 claim
lines denied over like 50,000worth of claims denied. And that
was nationwide. Every singlepayer in the nation, including
(20:31):
TRICARE, Humana was denyingthese claims that were actually
payable. So I was able to workwith AAOS, which is the
orthopedic society for thephysicians.
And they wrote a strongly wordedletter to this third party
vendor, letting them know thattheir edit was wrong. And they
(20:53):
were able to turn the edit offand advise the payers that the
edit was wrong. But then it wasup to us providers to pursue
with the payers to get paidbecause they did not proactively
reprocess and pay those claims.So that's really how I got
involved greatly with this payerlive stuff because if we hadn't
(21:17):
been communicating, that wouldhave, you know, just persisted.
And I've come to learn moreabout these payer audits.
There is AI going on, and we hadtalked about that last time we
talked as well. And the AI is inthe sense that there's a third
party that's reviewing claimsand suggesting audits for these
(21:42):
payers to turn on. And they'reeven showing them how much money
they'll save if they considerand turn on this edit. So while
I don't know that there's reallyAI going on as far as diagnosis
codes, because we know thatthere's E and M down coding
going on right now too. We'retrying to figure out the rhyme
and reason to that or thepattern to that.
(22:03):
But the AI that I see is thatthere's that the payers are
probably sharing edits or beingsuggested edits by their third
party vendor, which is not good.In my opinion, probably is along
the lines of antitrust.
Daniel Williams (22:22):
In the remaining time, want to ask you
a couple more questions.
Carol Ittig (22:25):
We
Daniel Williams (22:27):
just had a guest, Dr. Paula Ballester. You
introduced the two of us. Thethree of us met, we talked a
couple of weeks ago and werethinking about doing a show
together, all three of us. Andthen I started talking to both
of you and I went, No, y'allboth have such incredible
(22:47):
stories to tell.
I want to have y'all onseparately. But the reason I
bring that up is I just wantedto share yet again, that's you
networking, that's you makingconnections in the industry.
Tell us about anything you wantto share about your relationship
with Dr. Ballester and how y'allhave benefited each other
because y'all just had such acompelling story when I talked
(23:09):
to you.
Carol Ittig (23:10):
Yeah. So she's the director of utilization at our
affiliated hospital, and I workwith her on all types of things.
Specifically, if we have a priorauth that is still pended at the
time of surgery or we just comeup with any roadblocks or bumps
like in pediatrics. We have thisissue with inpatient only
(23:34):
procedures where peds, a lot ofthese fracture femur fractures
can be done outpatient andadults. They always have to be
inpatient because they requiretraction and things of that
nature.
But for kids, they just remodeltheir bone and you don't have to
do much. But there's always kindof issues with, they wanna
(23:56):
change the place of service orbecause it's required for prior
auth. It's kind of silly. Butanyways, through that, I got to
know her and I think she becamevery frustrated with this prior
auth process and started talkingabout coming up with a software
(24:17):
that would help providers withprior auth. Cause we know that
the payers must be using.
So well, we know they're usingsomething cause we saw the
lawsuits against PXDX. I can'tremember the other one, but
they're they're basicallylooking at certain data to
determine whether they're goingto approve the prior author or
not. So she took the idea ofbumping up the payer policies
(24:41):
against the documentation to seeif there were any deficiencies.
So once you make yourauthorization request, you are
prepared. So it might say, okay,yeah, it looks like this patient
is ready for you to submit priorauth except for like the payer
requests for requires six weeksof physical therapy and six
(25:03):
weeks of NSAID and you don'thave documented.
Well, you know that the patienthad physical therapy and you
know that they told you thatthey took NSAIDs, but for some
reason you didn't doc. So thenyou take the minute to go back
and you find the physicaltherapy records and do an
addendum to the note and recordthe NSAID usage, do an addendum
(25:23):
to your note or a memo or orwhatever it takes to make sure
that it's properly documented.So when you do give your or do
attempt your prior auth, it'sall right there and then you
don't give them a reason todeny. And then she also has a
tool if you do get denied yourprior auth, it can like comb
(25:43):
through your information andgive you kind of talking points
for the peer to peer review. Butthat's how we really got
involved.
And she also helped me with thisone particular patient. We had
over 90 emails going back andforth trying to get this patient
authorized for an injection, adiagnostic injection in the IR
(26:06):
department. And we could not getthe payer to approve the
injection until we ran the payerinformation and the
documentation through her AI,which is HIPAA compliant. And it
finally gave us all of theinformation we needed, which we
had. We just didn't present itin the right way to get that
procedure approved.
(26:27):
But that poor person wasa gymnast and wasn't able to
perform or compete because theywere in pain. Those poor
parents, all they wanted was fortheir child to be able to do
what they love. And we couldn'tget the prior auth approved even
though they had benefits andthey had all of the things
(26:49):
required. We just weren'tspeaking the same language.
Daniel Williams (26:52):
Right. I love you sharing that, and doctor
Ballester briefly touched onthat now as well. And I feel
like it's that movie Rashomon.It's a Japanese movie where they
tell the same story fromdifferent points of view. I'll
have to have the patient on hereas well now to to get the full
story.
Yeah. That is
Carol Ittig (27:12):
Or her parents. I mean,
Daniel Williams (27:13):
they're her poor parents.
Carol Ittig (27:15):
I mean, you know, a lot of the surgeries we do, you
know, like a single event multilevel surgery or like a spine
surgery, These parents, theyhave their mom or dad or brother
or sister fly in from out oftown to help them with the
recovery. Then to find out twodays before the surgery that it
didn't get authorized for someadministrative issue is just
(27:40):
devastating. These people taketime off of work and make travel
plans and arrangements. It's notgood for patient care.
Daniel Williams (27:49):
Well, I appreciate the work you're doing
and the work that Dr. Ballesteris doing as well. So last quick
question here before we signoff. You are so integrated into
MGMA. And when I talk to a lotof people at MGMA who are
members, when I read the surveyresults, the information we get
(28:10):
back, and we are very well awarethat it's often difficult to
find things on our website, howare you able to navigate?
How are you able to understand,Oh, right, here's the ACMPE or
here's the fellowship program orhere's Community Live or here's
another committee or anothervolunteer opportunity? What
(28:30):
secret sauce can you share withour listeners before we go to
help them navigate all thethings that are available at
MGMA so they're not missing goodstuff?
Carol Ittig (28:42):
Well, I'm just going to flatter you with my
response because I really don'thave the time to read a bunch of
emails and comb through thewebsite. And so if I'm looking
for something and I don't findit immediately, I I used to
email the library and I haven'tdone that in a year or so. So
hopefully that service is stillavailable, but because I
(29:02):
listened to your podcast everyweek, that's really how I'm
learning all about the differentthings that MGMA has to offer.
You know, I knew that there wasa mentorship program, but I
didn't know the depths of ituntil I heard the interview with
Dolores. And and that reallyresonated with me because of my
experience with my mentor.
(29:23):
But I think that I keep up todate by listening to you,
Daniel.
Daniel Williams (29:27):
Well, I did everyone, I did not plant that
question to get that answer.
Carol Ittig (29:32):
But that's that's true. It's true. And it makes it
easy for me because I can justlisten to you on the way to work
or on the way home and I havethe information I need.
Daniel Williams (29:45):
Okay. Well, wonderful. Well, Carol Ittig, it
has been such a pleasure to getto talk to you on the podcast.
Carol Ittig (29:52):
Thank you. You too.
Daniel Williams (29:54):
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 shownotes. We're also going to
provide an article as well witha lot of resources in there. So
until then, wishing you allhappy holidays, and thank you
all for being MGMA podcastlisteners.
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