Ukuqonda uMyinge weeAkhawunti ezifumanekayo
Iinjongo ezipheleleyo zokuphathwa kweemali ezifunyenweyo kukufezekisa ixesha elifutshane eliqokelelwayo. Iimali ezifumanekayo, ezibizwa ngokuba yi-akhawunti yezigulane, zibhekiselele kwimali engenayo eyakhiweyo kodwa ingaqokelelwanga. Ukuqinisekisa ukuhamba kwemali kukwanele ukuphathwa okufanelekileyo, i-ofisi yezobugcisa inexanduva lokunyusa i-revenue revenue potential.
Ukuphathwa kweeAkhawunti ezithengiweyo (AR) kubandakanya phantse yonke indawo yeofisi yezobugcisa.
Ulawulo oluyimpumelelo olufunyenweyo lweakhawunti lufuna ukuqonda ngokupheleleyo indlela ummandla ngamnye okanye isebe ngalinye elibhekiselele ngayo kwaye lichaphazela umjikelo wemali kunye nexesha lokuqokelela i-AR. Makhe sihlolisise nganye kwiindawo eziphambili ezisibhozo.
1. Iingcamango zomthetho
Iingcamango zomthetho zibandakanya ukuqonda nokulandela imimiselo yelizwe kunye nemimiselo. Indawo esoloko iyona nto ikhathazekayo kukuba ukukhwabanisa nokuxhaphazwa, ngokukodwa malunga ne-Medicare, Medicaid, kunye nezinye iinkqubo ezixhaswa ngemali.
Ukukhwabanisa kubhekisela kumabango ezonyango ngokuzenzekelayo nangokweqabileyo ngenzame yokukhwabanisa nayiphi na inkqubo yokuxhaswa ngemali ngemali. Iindlela eziqhelekileyo zobuqhetseba nokusetyenziswa kakubi zibandakanya ukuhlawula izixhobo ezingakhange zinikezelwe, ukuhlawulwa kweenkonzo ezingazange zenziwe, iindleko zokuhlawula umvuzo ukufumana isantya sokubuyisela ngaphezulu, nokuhlawula iindleko.
I-Ofisi yoMhloli-Jikelele (i-OIG) yenzele kwaye yakhupha izilumkiso ezikhethekileyo zobuqhetseba kuluntu loncedo lwezempilo.
Ezi zilumkiso zenzelwe ukupapasha iintlobo zobuqhetseba kwilizwe jikelele. Kwakhona yindlela yokubonelela kunye nokwazisa malunga nezenzo zobuqhetseba ngaphakathi kwoshishini kunye nokuphulwa kweedilesi ezithile kwi-Medicare neMedicaid Anti-Kickback Law.
2. Ikhontrakthi yokuxoxisana
Iingxoxo zentengiso kubandakanya ukuphuhlisa ubudlelwane bezemali kunye nemibutho yokunakekela.
Imibutho yokunyamekela imele ifike kuma-50 ekhulwini yemali engenayo yeenkonzo ezininzi zonyango.
Izivumelwano zokunyamekela ezilawulwayo zijongene nolwazi olunzulu kwinkqubo yokuthenga. Oku kubandakanya amaxabiso okubuyisela, imihla yokusebenza kunye nokuphelisa, izikhokelo zokufakela ibango, imigangatho yokuhlawula kunye nezinye izivumelwano.
Isicwangciso ngasinye sezonyango sobambiswano lweekhontrakthi sesebenzayo kwaye siya kusekelwe kwiimeko ezahlukeneyo, kodwa ezi ngcamango ezisisiseko mazigcinwe engqondweni:
- Yazi i-marhwebo: Ngaba uyazi ukuba yeyiphi ipesenti yemarike yakho, i-Medicaid, i-Cigna, i-Blue Cross Blue Shield, i-Aetna, i-United HealthCare okanye i-Uninsured? Uphononongo lweemarike unikeza ulwazi oluxabisekileyo olufunekayo kuzo zonke iingxoxo zentengiso.
- Yiba ngqiqo: Ukuqonda imeko yendalo yolondolozo olubandakanya iindlela ezahlukeneyo zokuhlawula ziya kukunika isiseko solwazi oluyimfuneko ukuba uthathe indlela efanelekileyo yokuthetha.
- Ukuqesha umcebisi: Imibutho emininzi ithembele ekuboniseni iinkonzo ukubonelela ngononophelo olulawulwayo oluxhomekeke kwingxowa-mali ngenxa yendalo enzima kunye neziganeko zomthetho ezibandakanyekayo.
Iseluleko somthetho sifanele sixoxwe kuyo yonke imiba yesikontrakthi xa kukho izinto ezibonakalayo kunye neendlela ezahlukeneyo kwimibutho okanye xa iingxaki zontsebenzo zingaphaya kobuchule bobunkokheli beofisi yezobugcisa.
3. Ukuthotyelwa
Ukuphuhlisa inkqubo yokuthobela iquka ukusekwa kwencwadana ebhaliweyo ichaza umgaqo wokuthobela kunye ne-Medical Office Code of Conduct. Uninzi lwemigaqo-nkqubo yokuthobela i-ofisi iquka iinkalo zomgaqo-mthethweni nezomthetho. I-OIG (i-Ofisi yoMhloli-Jikelele) inikezela ezi zihlandathu ezinika isiseko esiqinileyo kwinkqubo yokuthobela iofisi yezokwelapha.
- Ukuqhuba uphononongo lwangaphakathi nokuphicothwa;
- Ukuphunyezwa kokuthotyelwa kwemilinganiselo;
- Ukuqulunqa igosa lokuthobela okanye umnxibelelwano;
- Ukuqhuba uqeqesho olufanelekileyo kunye nemfundo;
- Ukuphendula ngokufanelekileyo ukufumana amacala kunye nokuphuhlisa amanyathelo okulungisa;
- Ukuphuhlisa imigca yokuvula; kwaye
- Ukunyanzeliswa kwemiqathango yoluleko ngokusebenzisa izikhokelo ezipapashwe kakuhle.
4. Amalungelo omonde
I-Ofisi yoLawulo lwaBasebenzi base-United States ichaza iinjongo ezintathu eziphambili ekuphuhliseni nasekusebenziseni amalungelo aPhepha.
- Okokuqala, ukuqinisa ukuzithemba kwabathengi ngokuqinisekisa ukuba inkqubo yokunakekelwa kwezempilo iyabulungisa kwaye iyayiphendula imfuno zabathengi, inika abathengi ngeendlela ezichanekileyo kunye neendlela ezifanelekileyo zokulungisa iingxaki zabo, kwaye ikhuthaza abathengi ukuba bathathe inxaxheba ekuphuculeni nasekuqinisekiseni impilo yabo.
- Okwesibini, ukuqinisekiswa ukubaluleka kobudlelwane obuqili phakathi kwezigulane kunye nabaqeqeshi babo bezempilo.
- Okwesithathu, ukuqinisekisile indima ebaluleke kakhulu abathengi badlala ekukhuseleni impilo yabo ngokuseka onke amalungelo kunye noxanduva lwabo bonke abathathi-nxaxheba ekuphuculeni isimo sezempilo.
Kukho indawo ezisibhozo eziphambili ezinxulumene namalungelo esigulane kwi-ofisi yezobugcisa.
- Ulwazi olunezigulane: izigulane zinelungelo lokufumana ulwazi oluchanileyo kunye nolwazi ngokucacileyo malunga nesicwangciso sabo sempilo, abaqeqeshi bempilo kunye namaziko enkonzo.
- Ukukhethwa kwababoneleli: izigulane zinelungelo lokukhetha ababoneleli ngeenkonzo zezempilo xa zifuna.
- Ukufikelela kwiinkonzo eziphuthumayo : izigulane zinelungelo lokunyango lwezonyango ngokungxamisekileyo kungakhathaliseki ukuba zikwazi ukuhlawula.
- Imvume enolwazi: izigulane kufuneka zivume kuphela unyango lwezempilo xa zineenkcukacha ezanele malunga nokuxilongwa kwazo kunye nazo zonke iindlela zokonyango ezifumanekayo njengoko ziyakwazi ukuyiqonda.
- Ukuhlonipha kunye nokungacaluli: izigulane zinelungelo lokuqwalasela, ukunyamekela ngokunyamekela kuzo zonke iinkonzo zonyango kunye nokungacaluli ekunikezeni iinkonzo.
- Ufihlakeleyo: izigulane zinelungelo lokunxibelelana ngasese kunye nokugcina imfihlo yolwazi lwabo olukhuselweyo ngabanye.
- Izikhalazo kunye nezibheno: izigulane zinelungelo lokwenza isigqibo esilungileyo nesebenzayo nasiphi na isikhalazo esenziwe kwiofisi yezobisi.
- Iimbopheleleko zonyango: izigulane zinomthwalo wemfanelo kwiofisi yezokwelapha kubandakanyeka inxaxheba kwiplani yabo yokwenza unyango, isisombululo esifike ngexesha elifanelekileyo kunye nentsebenziswano ehloniphekileyo nabo bonke abasebenzi.
5. Ufikelelo lweMonde
Impumelelo yeofisi yakho yezokwelapha ixhomekeke kakhulu kwiinkonzo zokufikelela kwiPatient Access (okanye abasebenzi basekupheleni). Umjikelezo weakhawunti yesigulane ivela ekungeneni kokuqala kolwazi lwesigulane sabantu. Ukwakha iqela lokufikelela kwegciwane le-dynamite kuyisinyathelo esibalulekileyo ekuphuculeni imizamo yokuhlawula kunye nokuqokelela kunye nokwandisa ukusebenza komjikelezo weengeniso.
Izizathu eziqhelekileyo ukuba kutheni amaqela amankonzo afikelela kwizigulane anesantya sokusebenza esingaphantsi kokungabikho kwezibonelelo ezifanelekileyo, ukuqeqeshwa ngokwaneleyo, kunye namanqanaba abasebenzi abaneleyo. Ngethamsanqa, ezi ziza kusombululwa ngokukhawuleza ngaphandle kweendleko ezinkulu.
6. Ukuhlawula ityala
Ukubaluleka kokuhlawulwa kwentlawulo kufuneka kuboniswe kuwo onke amasebe. Abasebenzi bekliniki kufuneka baqaphele uxanduva lwabo kwiimali ezifunyenwe ngamaxwebhu anobungqina kunye nefayili yentlawulo.
Isibambiso sesithintelo siquka ukudibanisa okufanelekileyo kweekhowudi zezokwelapha kwiinkonzo kunye neenkqubo ezenziwe ngexesha lokundwendwela isiguli. Ummandla ngamnye wekliniki udlala indima ebalulekileyo ekufikeleleni kwenkcazelo yokuchaneka kunye nokuchaneka kokuhlawula. Kukho ininzi enkulu yeendawo ezifaka isandla ekuhlawuleni ukufakwa, kuquka, kodwa kungaphelelanga:
- Inkathalo
- Ulawulo lweNkundla
- Unonophelo oluBalulekileyo
- ILebhu
- Maternity
- Iyunithi yezoNyango
- Impilo Yengqondo
- Nyukliya
- Ulawulo lwezinhlungu
- Lwezonyango
- La mayeza
- Ulungiso lwenyama
- Radiology
- Inkxalabo yokuNyango
7. Ulawulo loLwazi lwezeMpilo
Ulawulo loLwazi lwezeMpilo yinkqubo yokugcina, ukugcina nokufumana ulwazi lwezempilo lwesigulane ngokuhambelana neemfuno ze-Federal, State, kunye neemfuno zeejensi zokuvuma. Kukho iimbopheleleko ezilishumi ngaphakathi kwesikhokelo solawulo lweenkcukacha zempilo.
- UkuCoding Medical
- Ngonyango
- Uncedo lwezoNyango
- Uncedo lwabasebenzi bezonyango
- INdibano yeeNgxelo zezoLo
- Ukugcinwa kweeNgxelo zezoNyango
- UkuFiliswa nokuFumana
- Ubumfihlo kunye noKhuseleko
- Ukukhutshwa kolwazi
- Ukugcina Ubumfihlo
8. IiNkonzo zeMali eziMonde
IiNkonzo zezeMonde zoMonde zigqithiseleyo ukuzaliswa kunye nokuqokelela kwee-akhawunti ezifunyenweyo kwiofisi yezokwelapha.
Inkqubo yokuhlawula ngonyango idinga ulwazi olupheleleyo lwabahlawuli bomshuwalense kunye nemithetho nemimiselo yezoshishino zonyango. Iibhilizi zezezifo zonyango zijongene nokungeniswa ngexesha elifanelekileyo kwiimfuno zezobugcisa okanye zezonyango kwiinkampani zomshuwalense kubandakanywa iiofisi zonyango, izibhedlele, amakhaya angamahlengikazi, okanye enye indawo yokunakekelwa kwezempilo.
Iziphumo ezilandelelanayo zokulandelelana kweziqokelelo kwisisombululo esiphuthumayo sebango lakho lezempilo. Ukulandelwa kwamabango kufuneka kuqale ngokukhawuleza emva kweentsuku ezisixhenxe ukuya kwi-10 emva kokuba ibango lakho lingeniswe ngenkokhelo. Imizamo enokukhawuleza yokufumana ibango elihlawulwayo ayiyi kunciphisa kuphela iiferenti zakho iintsuku ezifunyenweyo kodwa iyakwandisa ukuhamba kwemali.
Abasebenzi abaneleyo kunye noqeqesho oluqokelelwayo olufanelekileyo baya kunika isiphumo esifanelekileyo kwisigaba sokuqokelela umjikelo wemali. Abasebenzi bezonyango kufuneka baqaphele amanyathelo asemqoka afanelekileyo ekulandelelweni ngokufanelekileyo kwee-inshorensi.
Intsebenziswano kunye nentsebenziswano yazo zonke iinkalo ezisibhozo ziyingxenye ebalulekileyo yokuphumelela kwee-akhawunti eziphathekayo. Nangona kukho izithintelo ezingalindelekanga ezinokuchaphazela ixesha lokuqokelela i-AR, yindlaliba yobunkokeli ukuchonga nokulungelelanisa le miqobo ekuphumeleleni kwintlangano.