Ikhowudi yezokwelapha yinxalenye ebalulekileyo yohlawulo lwezonyango kunye noonxibelelwano phakathi kwabanikezeli bezempilo kunye nabaqhankqalazi. Funda isiseko sendlela ithetha ngayo nendlela ezi zixhobo ezisetyenziswa ngayo.
Yintoni yokuCoding Coding?
Ikhowudi yezokwelapha yinkqubo yenobumba kunye neleta ebhaliweyo ezizodwa kwiisifo ngasinye, uphawu okanye uphawu olubekwayo, kunye nokubangela ukufa kwabantu.
Ukongezelela, iikhowudi zisetyenziselwa ukuhanjiswa okuqhelekileyo kwezibonelelo kunye neenkqubo ezisetyenziselwa unyango lweemeko zomntu. Ukubhalwa kweenkcukacha zezokwelapha ezichanekileyo kubalulekile ukuhlawula kunye nokulandelwa kwezibalo zesifo kunye unyango lwezonyango.
Ukwenza i-coding yezokwelapha kuyona nto ibalulekileyo ekufumaneni i-inshuwalansi kunye nokugcina iirekhodi zesigulane. Amabango okukhangela ngokuchanekileyo avumela ukuba umntu ohlawula i-inshorensi awazi ukugula okanye ukulimala kwesigulane kunye nendlela yokonyango.
Ikhowudi yezokwelapha ingabandakanya enye okanye ngaphezulu kwezi ntlobo zeekhowudi: iikhowudi ze-ICD, iikhowudi ze-CPT, iikhowudi ze-HCPCS, iikhowudi ze-DRG kunye ne-modifiers. Zonke ezi zixhobo zekhowudi zibalulekile ekunxibelelaneni nasezinjongo zokuhlawula. Akukona kuphela ukubhalwa kweenkcukacha ezibalulekileyo kwindlela yokwelapha, kubalulekile kuba ngabahlawuli bezorhwebo ezifana neenkampani zomshuwalense, i-Medicare ne-Medicaid abayi kuhlawula ibango ukuba ayinakungeniswa ngokufanelekileyo kunye neikhowudi ezamkelekileyo.
Iikhowudi ze-ICD
Uhlobo lokuShwankathela ngamaZwe weZifo okanye iikhowudi ze-ICD yinkqubo enye yeekhowudi. Ezi zizodwa ukucacisa ukuxilongwa, iimpawu kunye nezizathu zokufa kubantu. I-World Health Organisation yenza, iikopi, kwaye ijongene nokuhlelwa kwezi zigaba kwaye ziyimilinganiselo kwaye ziyabonakala zonke iziko lonyango kunye nezobugcisa emhlabeni wonke.
E-United States iZiko leSizwe leMatriki yeeMpilo, eliyinxalenye yamaziko e-Medicare kunye neeNkonzo zeMedicaid ilawula zonke izilungiso kwiikhowudi ze-ICD kunye ne-WHO.
Iikhowudi zeHCPCS
I-HCPCS (I-System Care Coding System System) amanqanaba I no-II enye inkqubo yokubhala. Inqanaba ndiqulethe iikhowudi ze-CPT, kunye neNqanaba II kubandakanya iikhowudi zeefayili ezisetyenziselwa ukuchonga iimveliso, ukubonelela kunye neenkonzo ezingabandakanyi kwiikhowudi ze-CPT xa zisetyenziswe ngaphandle kweofisi yonyango.
Iikhowudi ze-HCPCS zichazwe kumanqanaba amathathu:
- Inqanaba I-CPT (i-Current Procedural Terminology) iikhowudi zenziwe ngamanani anama-5 kwaye zilawulwa yi-American Medical Association (AMA). Iikhowudi ze-CPT zisetyenziselwa ukuchonga iinkonzo zonyango kunye neenkqubo eziyalelwe ngamagqirha okanye nabanye abaqeqeshi abanelayisenisi.
- I-HCPCS yeNqanaba II yiinkcukacha zee-alphanumeric eziqulethwe yileta enye ye-alfabhethi elandelwa ngamanani amane kwaye ilawulwa yiCandelo le-Medicare ne-Medicaid Services (CMS). Ezi khowudi zichonga iinkonzo ezingezizo ugqirha ezifana neenkonzo ze-ambulensi, izixhobo zonyango ezizinzileyo kunye nekhemisi.
- Iikhowudi zeNqanaba III zikhowudi ze-alphanumeric W, X, Y, okanye Z ezilandelwa ngekhowudi eneenombolo ezine. Ngenye indlela eyaziwa njengeikhowudi zendawo, ezi khowudi zisetyenzisiweyo njengekhowudi eyahlukileyo xa kungekho nqanaba I okanye ikhowudi ye-II ukuyichonga.
Iinguqulelo: Ezinye iikhowudi ze-HCPCS zifuna ukusebenzisa i-modifiers. Ziqukethe inombolo yeenombini ezimbini, iileta ezimbini okanye iilwimi ze-alphanumeric. I-modifier code ye-HCPCS inikezela ngolwazi olongezelelweyo malunga nenkonzo okanye inkqubo eyenziwa. Izilungiso zisetyenziselwa ukuchonga indawo yomzimba apho kwenziwa inkqubo, iinkqubo ezininzi kwiseseshoni efanayo, okanye zibonisa ukuba inkqubo yaqalwa kodwa yavalwa.
Iikhowudi ze-CPT
Iikhowudi ze-CPT ziNkqubo zeNkqubo eziqhelekileyo kwaye zaphuhliswa kwaye zenziwa nguMerika Medical Association ngo-1966. Le yinkqubo yeendlela ezinhlanu zeefayili ze-alphanumeric ezichaza ngendlela echanekileyo yonyango, iinkonzo zokugqirha kunye nokuxilonga.
Iikhowudi ze-DRG
Iikhowudi ze-DRG, iikhowudi zokudibanisa ezinxulumene nokuxilongwa, zisetyenziselwa ukukhuphela iimfuno zamathambo. Abaninzi batshorensi bahlawula ngokwe-DRG, ngoko ke, ukuchaneka kwazo zonke izixhobo kubalulekile ekuhlawuleni ibango elifanelekileyo.
Ukusetyenziswa kweCoding yezoLimo
Ezi zixhobo zokubhala zibalulekileyo zokunxibelelana kunye neenjongo zokuhlawula. Akunjalo nje kuphela ukubhalwa kweenkcukacha ezibalulekileyo kwindlela yokwelapha, kubaluleke kakhulu kwizezimali kubaboneleli bezonyango kuba abahlawuli bezentengiselwano ezifana neenkampani zomshuwalense, i-Medicare neMedicaid abayi kuhlawula ibango xa kungeniswa ngokufanelekileyo ngeekhowudi ezamkelekileyo.
Ukongezelela, iikhowudi zokuxilongwa zisetyenziselwa ukuhlalutya iipatheni zesifo kwiintlalo kunye nakwiimvavanyo zezempilo kunye nokufa kwelizwe. Amazwe aseLungu loMbutho wezeMpilo wehlabathi angakwazi ukuzuza kwiinkcukacha ezifunekayo zokulwa nemicimbi yezempilo ephakamileyo, ukufundisa abantu ngokuthintela nokukhusela, nokuqinisekisa impilo kunye nezobuhlali kubommi babo.
Imfundo kwiCoding Medical
Iikholeji ezininzi kunye nezikolo zorhwebo zinika iiklasi, izatifikethi, kunye neeDiskridi ze-Applied Science ezidibeneyo kunye nokuhlawula i-medical and coding. Ezi zifundo ezinzulu okanye izicwangciso zamanqanaba ezifundisa abafundi kwisigama sesiganeko, iikhowudi ezifanelekileyo kunye neendlela zokubakhombisa, iinkqubo ezifanelekileyo zeofisi kunye nenani leenkalo ezihambelanayo. Ezinye zazo zivunyelwe kwaye ezinye azikho, ngoko umfundi ngamnye onokukwazi ukwenza umsebenzi wakhe wesikolo ngaphambi kokukhetha inkqubo yokufunda.
Ukubaluleka kwemfundo yokuqala kunye nemfundo eqhubekayo kwiklinikhi okanye kwi-ofisi yegqirha ayinakugqithiswa. Ukuhlala ulungelelaniso lweenguqu zokukhokhwa kweenkcukacha kunye neendlela zokuhlawula, kunye nemigaqo yolawulo kubalulekile kule nkqubo yedijithali ehamba ngokukhawuleza apho sonke sisebenza khona siphile.
UkuCoding kunye neBilling
Ukuqhafaza kunye nokuhlawula kudlalwa ndawonye ngokuba zizinto ezimbini zeofisi yezonyango ezixhamene ngokuthe ngqo. Abasebenzi (abaqeshwa) abagqiba ukubhalwa kwekhowudi yakho kunye nokuhlawula kufuneka basebenze ngokubambisana ukuqinisekisa ukuhlawulwa okuchanekileyo kunye nokukhawuleza kwazo zonke izibango zonyango kwaye bachane kwaye bazalise iirekhodi zonyango.
Izibonelelo ezinjengeencwadi zekhowudi zexesha lokubhala uluhlu lweenkcukacha ezahlukeneyo okanye i-software yangoku yokubhalisa okanye ukuhlawula kuyimfuneko kubasebenzi bentlawulo kunye nabasebenzi bekhowudi ukwenzela ukuba baqinisekise ngokuchanekileyo kwiinkampani zomshuwalense okanye kwi- Medicare ne-Medicaid , kunye nokukhawuleza ukuhlawulwa kwezi zixhobo, kunye ukuxilongwa ngokuchanekileyo kunye neirekhodi zonyango. Ukongezelela kokuqala kokufaka izibhengezo zesigulane, umgcini wekhowudi kunye okanye umqashi angabangela uxanduva lokulandela amabango aphikisiwe ngokuphicothwa kwitshati yesigulane, ukufaka kwakhona ibango, ukubhenela ibango, okanye ukuthatha amanye amanyathelo ukuqinisekisa ukuchaneka Kleyima.
Ngenxa yokuba abasebenzi bezonyango kunye nabahlawulayo banembopheleleko yokuchaneka kwamarekhodi ezonyango ngokuhambelana nemimiselo kaRhulumente kunye nemimiselo kunye nokubaluleka kweebhanki ezifanelekileyo kunye namakhowudi akakwazi ukuxinwa. Isibonelelo sezempilo esiphumeleleyo kufuneka sibe namaqeqeshwe aqeqeshwe kakuhle, ahlelweyo, kunye nabaqeqeshi bezonyango abanezakhono kunye neenkcukacha zezokwelapha.