Imirhumo ye-Medicare ayifanele ibe nemiphumo eninzi kunye nokukhanyela ukuba unolwazi olufanelekileyo lwezikhokelo zokuhlawula i-Medicare. Iinkcukacha ezinikeziweyo ngezantsi ziyenzi kwaye azikho izinto eziqhelekileyo ukukhusela iimpazamo zokuhlawula.
Ungakulibala ukutyelela i-website ye-CMS ukuba ube neetoni zokufikelela ezincedisayo, izikhokelo kunye nempapasho enokuba luncedo kwi-Medicare.
Yintoni oyenzayo yokuhlawula ngezoNyango
Ngaba ikhowudi ibanga ngokuchanekileyo kusekelwe kwiinkonzo, iimvavanyo kunye neenkqubo ezenziwe.
Ingaba uxwebhu lwengxelo yonyango kunye nenkcazo echanileyo yazo zonke iinkonzo, iimvavanyo, kunye neenkqubo ezichanekileyo ezenziwe kwaye zichaneke ngokufanelekileyo ngempawu zesigulane, izikhalazo, izimo, izifo kunye nokulimala.
Ingxelo yenkqubo yeCCT / HCPCS kwiMedareriyo echazwe ngokuthe ngqo kumaphepha kwirekhodi yezokwelapha.
Khetha kwaye ubike iinguqu ezifanelekileyo kwiikhowudi ze-CPT / HCPCS kwibango ngokwemiqathango ye-Medicare.
Ngaba ziquka ubude bexesha, ubukhulu bonyango, okanye inani leeyunithi kwiirekhodi zezokwelapha zokunika ingxelo echanekileyo kwibango.
Ingxelo ye- ICD-9 yokuxilongwa kwiinkcukacha ezichaseneyo zihambelana neempawu zesigulane, izikhalazo, izimo, izifo kunye nokulimala okuchazwe kwingxelo yonyango yesigulane.
Yenza izicelo zebango zingakunyaka omnye womhla wenkonzo ye-Medicare yokuqala kunye ne-MSP.
Yenza ingxelo ngeeyunithi zenkonzo ezisekelwe kwiNational Initiative Coding Initiative (NCCI) kunye neeMveli ezingaHlengiyo (ii-MUEs) ukukhusela ukunika iinkonzo ezininzi okanye iinkqubo ezingafanele zihlawuliswe kunye ngenxa yokuba enye inkonzo okanye inkqubo inokubandakanya enye okanye ngenxa yokuba kungenakwenzeka ukuba kwenziwa kweso sigulane ngosuku olunye.
Ngaba unayo iSaziso seNcediso soMhlomulo ( Advance Beneficiary Notice ) kwi-fayile ukuze uxwebhu oluchanekileyo lwenkonzo olungabonakaliyo kunye ne-modifier efanelekileyo, oko kukuthi i-GA okanye i-GZ, eya kuchonga iinkonzo ezinokuhlawulwa okanye ezingakhokhiswa kwisigulane.
Yenza isayinwa kwisigulane isigunyaziso sokunikezelwa kwezibonelelo, ukuvumela umboneleli ukuba afumane isigunyaziso kunye nokubonelela.
Qinisekisa ukufaneleka kwesigulane kwiFayile eSebenzayo yokuSebenza (CWF) ngaphambi kokuhlawula ibango ukuqinisekisa ukuba ulwazi lomguli aluzange lushintshe.
Oko akufanele ukwenze kwiBillare Billing
Musa ukuhlawula nayiphi na inkonzo, uvavanyo, okanye inkqubo eyenziweyo xa kungekho zikhokelo zeempawu, izikhalazo, izimo, izifo kunye nokulimala okunika ubungqina ngaphandle kokuba kusetshenziswe ikhowudi yokucoca.
Musa ukubika iinkqubo zenkqubo yenkqubo yeCPT / HCPCS ezingenakucwangciswa xa kukho iinkqubo ezithile ze-CPT / HCPCS.
Ungazenzeli ngokuzenzekelayo ii-modifiers kuzo zonke i-CPT / HCPCS xa irekhodi lonyango lingayisebenzisi ukusetyenziswa kwalo.
Musa ukuhlawula iinkonzo, iimvavanyo okanye iinkqubo ngokwahlukileyo okumele zifakwe ndawonye ngenxa yokuba zithathwa njengenxalenye yenkonzo, uvavanyo okanye inkqubo.
Musa ukuhlawula izidakamizwa ezilawulwayo kunye nokuphelisa kunye. Imali echithekayo kufuneka ihlawulwe kumgca ohlukeneyo kwaye iboniswe nge-JW yomguquleli.
Musa ukuhambisa amabango kwi-Medicare ngenkokhelo ukuba isiguli sigqitywe nguMnxeba oPhathayo.
Ungangenisi iindleko zeeVipunctures (36415) kwi-Claims ye-Medicare Part B. Oku kunokuhlawulwa nje njengenxalenye yesibhedlele esibhedlele.
Musa ukuhlawula iimviwo zangokwenyama ngokuqhelekileyo ngaphandle kokuba uhlawula ukufumana ukukhanyela. Ukuba ukuhlawula ukukhanyela, qiniseka ukuba ungeze umguquleli we-GY kwikhowudi yeProgram yeCCT / HCPCS efanele.
Musa ukuhlawula iiNkonzo ze-Medicare Part B xa isigulane ukhethe i-Hospice ekwenzeni unyango kunye nokulawulwa kwesifo sokuphela.
Ungangenisi izimangalo zamaphepha kwinto nayiphi enye ngaphandle kweyomgangatho, obomvu kunye nomhlophe weCMS-1500 okanye i-UB-04 ifomu.