Impazamo yokuCoding ingakubiza imali
Iikhowudi ze-inshorensi zisetyenziswe kwisicwangciso sakho sezempilo ukwenza izigqibo malunga nokuba uhlawule njani ugqirha kunye nabanye ababoneleli ngezempilo. Ngokuqhelekileyo, uza kubona ezi khowudi kwiNkcazo yeeNzuzo kunye neengxelo zeebhili.
Inkcazo yeeNzuzo (i-EOB) yifom okanye umqulu onokuthunyelwa kuwe kwinkampani yakho yomshuwalense emva kweeveki okanye kwiinyanga emva kokufumana inkonzo yonakekelo yezempilo ehlawulwa yinkampani yinshuwalense.
I-EOB yakho ifestile kwimbali yakho yokuhlawula ngonyango. Hlaziya ngokucophelela ukuqinisekisa ukuba ngokwenene ufumene inkonzo enikezelwayo, imali oyenayo ugqirha wakho kwaye isabelo sakho sisilungile, kwaye ukuba ukuxilongwa kunye nenkqubo yakho ibhalwe ngokufanelekileyo kwaye ikhowudiweyo.
Ukubaluleka kweeNtsholongwane
I-EOBs, iifom zamabango e-inshurensi, kunye neendleko zonyango ezivela kugqirha wakho okanye esibhedlele kunokuba nzima ukuyiqonda ngenxa yokusetyenziswa kwamakhowudi ukuchaza iinkonzo ezenziwe kunye nokuxilongwa kwakho. Ezi khowudi zihlala zisetyenziselwa endaweni yeNgesi ecacileyo kwaye kunokunceda ukuba ufunde malunga nale khowudi, ingakumbi ukuba unayo okanye enye ingxaki engapheliyo yezempilo.
Ngokomzekelo, izigidi zabantu baseMerika ziluhlobo lwesibini sikashukela kunye nexinzelelo legazi eliphezulu kunye ne-cholesterol ephakamileyo. Eli qela labantu lingaba neenkonzo zezempilo ezingaphezulu kuneMelika ephakathi kwaye, ngoko ke, kuya kufuneka ukuba bahlalutye ii-EOBs kunye neendleko zonyango.
Iinkqubo zoCoding
Izicwangciso zezeMpilo, iinkampani zenkxaso-zonyango, kunye nababoneleli ngezempilo basebenzisa iindlela ezintathu zokubhala iinkcukacha ezahlukeneyo. Ezi khowudi zenzelwe ukuqiniseka ukuba kukho indlela eqhubekayo neyithembekileyo yeenkampani ze-inshorensi yezempilo ukuqhuba amabango avela kubaniki-zonyango kunye nokuhlawula iinkonzo zempilo.
Isiganeko samanje seNkqubo
Iikhowudi zeNkqubo zeNkqubo zamanje (CPT) ezisetyenziswa ngamagqirha ukuchaza iinkonzo ababonelela ngazo. Ugqirha wakho akayi kuhlawulwa ngesicwangciso sakho sezempilo ngaphandle kokuba ikhowudi ye-CPT ibalwe kwifom yebango.
Iikhowudi ze-CPT zenziwe kwaye zihlaziywa yi-American Medical Association (AMA). Ngelishwa, i-AMA ayinikezeli ukufikelela okuvulelekileyo kwiikhowudi ze-CPT. Abahlawuli bonyango abasebenzisa iikhowudi kufuneka bathenge iincwadi zokubhala okanye ukufikelela kwiikhowudi ezivela kwi-AMA.
Indawo ye-AMA ikuvumela ukukhangela ikhowudi okanye igama lenkqubo. Nangona kunjalo, umbutho unqanda ukuba ungabi ngaphezu kwama-5 uphando ngosuku (kufuneka wenze i-akhawunti uze ungene ngemvume ukuze ukwazi ukusebenzisa umtshini wokukhangela). Kwakhona, ugqirha wakho unokuba nephepha (elibizwa ngokuba yifom ye-encounter okanye "i-superbill") e dwelisa i-CPT eqhelekileyo kunye neendlela zokuxilonga ezisetyenziswa kwiofisi yakhe. Iofisi yakho yonyango ingabelana ngale fomu nawe.
Ezinye imizekelo yeekhowudi ze-CPT zi:
- 99201 - iofisi okanye olunye uhambo olutyelelo lokuhlola nokuphathwa kwesigulane esitsha
- 93000 - i-electrocardiogram
- 36415 - ukuqokelelwa kwegazi eliphambene nomhlaba ngokuthunjwa kwegazi (ukudweba igazi)
Inkqubo yoLuntu lweNkqubo yeCoding System
Inkqubo yeCoding Coding System (Health Coding System) (i-HCPCS) yinkqubo yokubhala i-Medicare.
Amanqanaba Iikhowudi ze-HCPCS zifana neendlela ze-CPT ezivela kwi-American Medical Association.
I-Medicare nayo igcina isethi yamakhowudi eyaziwa njengeHCPCS iNqanaba II. Ezi khowudi zisetyenziselwa ukuchonga iimveliso, ukubonelela kunye neenkonzo ezingenakunikwa kwiikhowudi ze-CPT, ezifana neenkonzo ze-ambulensi kunye nezixhobo zonyango ezihlalayo (izihlalo zamasondo kunye nezibhedlele zesibhedlele), i-prosthetics, orthotics, kunye nempahla esetyenziswa ngaphandle kweofisi yakho.
Ezinye izibonelo zeNqanaba II zeHCPCS zikhowudi:
- L4386 - ukuhamba ngokuqaqambileyo
- E0605 - i-vaporizer
- E0455 - intente ye-oxygen
Amaziko e-Medicare kunye neeNkonzo zeMedicaid agcina iwebhusayithi apho ihlaziywa ulwazi lwekhowudi ye-HCPCS lufumaneka kuluntu.
Ulwahlulo lwaMazwe ngamazwe
Inkqubo yesithathu yokwenza ikhowudi yi-International Classification of Diseases, okanye iikhowudi ze-ICD. Ezi khowudi, eziphuhliswe yi-World Health Organisation (WHO), zichonge imeko yakho yempilo, okanye uhlolisise. Iikhowudi ze-ICD zidla ngokusetyenziswa kunye neefowuni ze-CPT ukuqinisekisa ukuba imeko yakho yempilo kunye neenkonzo ozifumene.
Ngokomzekelo, ukuba ufumanisa i-bronchitis kwaye ugqirha wakho wayala i-X-ray ye-ankle, mhlawumbi i-X-ray ayiyi kuhlawulwa ngenxa yokuba ayihambelani ne-bronchitis. Nangona kunjalo, i-X-ray isifuba ifanelekile kwaye iza kubuyiselwa.
Ezinye imizekelo yeekhowudi ze-ICD-10 zi:
- E66.0 - ukukhuluphala ngenxa yeekhalori ezingaphezulu
- F32.0 - ukudandatheka okunyameko
- S93.4 - i-ankle
Uluhlu olupheleleyo lweekhowudi zokuxilonga (ezaziwa ngokuba yi-ICD-10) ziyafumaneka ukukhuphela kwiwebhusayithi ye-CMS, kwaye i-ICD10data.com yenza kube ngokuchanekileyo ukukhangela iikhowudi ezahlukeneyo.
I-US ishintshile ukusuka kwi-ICD-9 ukuya kwiikhowudi ze-ICD-10 ngo-2015, kodwa ezinye iinkqubo zokunakekelwa kwezempilo zanamhlanje zenze i-ICD-10 iminyaka emininzi ngaphambili. Iikhowudi ze-CPT ziyaqhubeka zisetyenziselwa ngokubambisana neekhowudi ze-ICD-10 (zombini zibonisa kwiimali zonyango), kuba iikhowudi ze-CPT zihlawula imali, kanti iikhowudi ze-ICD-10 ziyi-documenting diagnostics.
Iimpazamo zokuCoding
Ukusebenzisa iinkqubo ezintathu zokunxibelelana kungabangela umxhatshazi ogqirha kunye nabaxakekile esibhedlele abasebenzi kwaye kulula ukuqonda ukuba kutheni iiphoso zokubhala. Ngenxa yokuba isicwangciso sakho sezempilo sisebenzisa iikhowudi zokwenza izigqibo malunga nokuba uhlawule ugqirha kunye nabanye ababoneleli ngezempilo, iimpazamo zinokubhatala imali.
Ikhowudi engafanelekanga iyakubhala ngeemeko ezinxulumene nempilo ongenayo ( kusekho ukukhathazeka ukuba imeko ekhoyo ngaphambili iyakwazi ukuba ngumqobo wokufumana inkxaso yezempilo phantsi kwemizamo yokulungisa uncedo lwezempilo lwe-GOP), kubangele ukuhlawulwa ngokugqithisa ugqirha wakho. kwaye unokwandisa iindleko zakho ngaphandle kwe-pocket , okanye isicwangciso sakho sezempilo singakhanyela ibango lakho kwaye ungahlawuli nto. Kunokwenzeka ukuba ugqirha wakho, igumbi lesiganeko, okanye isibhedlele ukuba ungayibhalisi iinkonzo ezithe zafumana, nokuba ubhale i-diagnostic engafanelekanga okanye inkqubo engalunganga. Kulula nokuba neempembelelo zepaygragraphical errors.
Umzekelo: UDoug M. wehla xa egijima. Ngenxa yentlungu ekhanda lakhe, waya kwindawo yakhe yokuphucula. Emva kokuba ne-X-ray ye-ankle yakhe, ugqirha we-ER ufumene i-ankle etyunjiweyo waza wathumela ikhaya likaDoug ukuba aphumle. Kwiiveki ezimbalwa emva koko uDoug wathabatha ibhilikhithi esibhedlele angaphezu kwama-$ 500 kwi-X-ray yeenyawo. Xa i-EOB yakhe ifike, waqaphela ukuba icebo lakhe lempilo lalingavumi i-X-ray.
UDoug wabiza icebo lakhe lempilo. Kuthatha ixesha elithile ukulungisa iphutha elenziwe ngumbhalisi wenkokhelo kwigumbi lokuphucula. Wafake ngengozi inamba engafanelekanga kwikhowudi yokuxilongwa kukaDoug, etshintsha i-S93.4 (i-ankle ehlanjwe) kwi-S53.4 (i-elbow sprained). Isicwangciso sezempilo sikaDoug saliphika ibango ngenxa yokuba i-X-ray ye-ankle ayiyiyo vavanyo eyenziwa xa umntu enobungozi bomlenze.
Kukho amanyathelo amaninzi kwinkqubo yokuzalisa nokuthumela ibango lonyango. Ngendlela, abantu kunye neekhompyutheni ezibandakanyekayo kwinkqubo zingenza iimpazamo. Ukuba ibango lakho liphikisiwe, ungaba neentloni ngokubiza zombini iofisi yakho ugqirha kunye nesicwangciso sakho sezempilo.
> Imithombo:
> American Medical Association. Ukufumana izixhobo zeCoding.
> Bohnett, uCharlotte. WebPT. Izinto Ezifanele Uzazi Ngoku Ngokuphathelele ICD-10. Julayi 2013.
> Amasebe e-Medicare neeNkonzo zeMedicaid. Ukuhlaziywa kwekota kweHCPCS.
> ICD10data.com. I-Web's Free 2018 ye-ICD-10-CM / PCS yeCoding Reference Reference.