ASC Billing Basics

Iimali zokubhengezwa kweeNkundla zamatyala okuBulala

Isikhungo sokuPhepha esisisigxina (ASC) sichazwa yiCMS njengesibonelelo ngenjongo yodwa yokubonelela ngeenkonzo zokugulisa izigulane. Amacandelo okuphucula amaxhala angabonwa ngeziko elisekelwe esibhedlele okanye ingaba yindawo evulelekileyo yokugulisa.

Nangona iimfuno ze-ASC zinezinye izinto ezifanayo kwizibango zesibhedlele xa kuziwa kwi-billing, kukho ezinye iimeko ezahlukileyo kakhulu.

Iifom zeeNkcazo ze-ASC zeBango-Yiyiphi eyokusetyenziswa

Izibango zesikhungo sokuphaphaza zixhaswa kwi-Medicare, i-Medicare Benevantage Plans, kunye neMedicaid kwi-HCFA 1500 okanye i-837P. Oku kwahluke kwiimfuno zokuhlinzwa zonyango ezibhedlele, ezifakwe kwi-UB-04 okanye kwi-837I.

I-CMS-1500 yinkoyi ebomvu kumaphepha amaphepha amabango asemthethweni asetyenziswa ngamayeza kunye nabanikezeli bebango lokubakho. Nabani na ababoneleli bamaziko kunye nomthengisi bangasebenzisa i-CMS-1500 kwiibango zonyango lokuhlawula. Inkcazelo yekhompyutheni ye- CMS-1500 ibizwa ngokuba yi-837-P, i-P imele ifomathi yobugcisa.

I-UB-04 okanye i-837-ndisebenzisa i-ASCs ukufaka iibango zonyango kubo bonke abanye abahlawuli.

Kaninzi

Uhlobo loYilwayo lwe-ASC

Xa uthumela amabango kwi-UB-04, uhlobo lwebhilidi yeimfuno ze-ASC ziyi-83X. Idijithali yokuqala ibhekisela kuhlobo lwesibonelelo: 8 - Isibonelelo soBodwa, isibhedlele se-ASC esibhedlele Inombolo yesibini ibhekisela kwisigaba sobhengezo: 3 - Isigulane

Inombolo yesithathu ibhekisela kwixesha elimelwe ngasentla nge-X variable.

1 - Yamkela ngokuKhutshwa kweMali

7 - Ukutshintshwa kweBango eliPhambi okanye iBango eliLungisiweyo

8 - Ukukhutshwa okanye ukuChoxiswa kweBango eliPhambi

Code Revenue

Xa uthumela amabango kwi-UB-04, ikhowudi yentlawulo esetyenzisiweyo ukunika iinkqubo zogqirha zogqirha i-490.

Ukusetyenziswa kweeNguqulelo

Iimangalo ze-ASC zingabadibanisa kuba abahlawuli abahlukeneyo abafunanga kuphela iintlobo ezahlukeneyo zefom zentsholongwane, nazo zifuna ukusetyenziswa kweziguquli ezahlukeneyo.

Abagulayo beMedare

I-Medicare idinga iinguqulelo ezilandelayo xa kufakwa iikhowudi ezithile zeenkqubo ze-ASC:

Iinguqulelo RT - Uhlangothi lwesokudla (elisetyenziselwa ukuchonga iinkqubo ezenziwe ngakwesokudla komzimba)

I-Modifier LT - Ikhohlo lasekhohlo (elisetyenziselwa ukuchonga iinkqubo ezenziwe kwicala lasekhohlo lomzimba)

I-Modifier TC- Icandelo lobuchwepheshe

Iinguqulelo 52 - Iinkonzo ezincitshiswayo

Iinguqulelo 59 - Inkqubo eyahlukileyo eyahlukileyo

Iinguqulelo 73 - Inkqubo yokucima emva kokulungiselela ukuhlinzwa

Iinguqulelo 74 - Inkqubo enqunywe emva kwe-anesthesia elawulwayo

Umhleli weFB - Idivaysi enikezelwe ngaphandle kweendleko / ityala elipheleleyo

I-Modifier FC - Idivaysi enikezelwe ngetyala lesikhathi

Umhleli we-PA - Inxalenye engafanelekanga yomzimba

Umhleli wePB - Ugqirha olungalunganga isigulane

I-PC yomguquleli - Ukuhlinzwa okungalunganga kwisigulane

I-Modifier PT - Inkqubo yokujonga i-Colorectal iguqulwa kwi-diagnostic okanye inkqubo yokwelapha / utyando

I-Modifier GW - Ukuguqulwa okungahambelani nezigulane zezigulane zezigulane

I-Medicaid Modifier

Nangona i-Medicare isebenzisa ezi ziguquli, i-Medicaid ayifuni ukusetyenziswa kwanoma yiyiphi yala. Umququzeleli osebenzayo kuphela weMedicaid ngu-modifier SG ogqithisa ibango njengesibango sokubamba izibhedlele.

Kubalulekile ukufaka ishintsho kwiSG kwiikhowudi nganye ye-CPT kungakhathaliseki ukuba umhlawuli ukwenzela ukwahlula ukuhlawulwa kwebango kwinqanaba leprofeshini enye inkonzo.

Amanye amaGuquli

Omnye umzekelo wokumahluko ekusebenziseni i-modifiers kukuba i-Blue Cross Blue Shield ** idinga ukusebenzisa i-modifier 50, eyahlula inkqubo njengemibandela yomhlaba, kunye neenkonzo ezimbini. Ngakolunye uhlangothi, i-Medicare idinga i-modifier 50 okanye i-RT kwaye i-LT kwimigca eyahlukileyo kunye neyunithi yesevisi.

** Izikhokelo zentlawulo ziyahlukahluka ngurhulumente. Hlola nge-BCBS yomgaqo-nkqubo welizwe ukuze ufumane.