Indlela yokufunda iiBhilile zakho zeDolophini okanye ezinye iiBill zonyango

Kukho ubuninzi beenkcukacha kwiibhilikhwe zakho zonyango

Xa ugqiba ukuthatha amanyathelo okulawula iindleko zakho zezempilo, ukwazi ukufunda oogqirha bakho kunye nezinye iindleko zonyango ziya kuza.

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Zonke iiBill zeZonyango zinemiSebenzi efanayo

Kukho iziqendu ezintathu zamaphepha oza kulufuna ukuthelekisa.

1. Uluhlu lweenkonzo ezenziwe. Oku kunikezelwa kuwe xa ushiya iofisi yegqirha okanye indawo yokuvavanya.
2. Umthetho osayilwayo ugqirha okanye isikhungo sezempilo sikuthumela. Luluhlu lweenkonzo ezivela # # ngasentla, kunye neentlawulo zenkonzo nganye. Le bhili iyaqwalaselwa kule nqaku.
3. Inkcazo yeenzuzo - i-EOB - evela kumhlawuli wakho (umshwalense, iMedare okanye omnye umhlawuleli).

Phakathi kwamaphepha amathathu, uzakufumana isigama kunye neikhowudi eziza kukunceda uqiniseke ukuba uhlawulwa kuphela ngeenkonzo ezenziwe.

Siza kuqala ngokukhangela ibhilikhi yezobisi ezisisiseko, owokufumana kwigqirha okanye omnye umboneleli.

Ibhilikhi yakho yonyango inokuthi ingabonakali njengaye, kodwa iya kuba neenkcukacha ezifanayo.

Uza kubona yonke into ukusuka kwimini yenkonzo ukuya kwiinkonzo ezinikezelwe kwiindleko kwibhili yakho.

Kule bhili-mali, ikholomu ye "Pat #" ithetha ukuba zeziphi izigulane kwi-akhawunti yakho zamkela inkonzo. Ekubeni mna ndiyena-inshurensi, i-1 ibhekisele kum.

"Prv #" isetyenzisiwe yiofisi yam ugqirha ukuba uthethe ntoni na oogqirha endababona. # 51 ngugqirha wam.

Kwaye i-Bs phantsi kwe "Msg" ibhekiselele ekubeni bayayikhokhisa umshurensi wam.

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Inyathelo 2 - Fumana uluhlu lweeNkonzo kwiBhili yakho yezoLimo

Ibhilikhi yegqirha yakho iya kubhala iinkonzo ezibonelelwe zona. Yintoni onokuyifunda ngabo?

Uninzi lwamagama alingaqhelekanga!

Ukuze ufunde oko kuchazwa isigama, sebenzisa isichazi sezonyango okanye uluhlu lweemvavanyo zonyango.

Kwimizekelo engentla, ndiyakwazi ukujonga amagama afana:

"IPelen Panel" ekhangele ukuba ibe vavanyo lwamanqanaba e-cholesterol yam.

"Thyroxine Free" ebonakala ngathi i-thyroid test.

Isiqhosha apha siza kuluhlula ezi nkonzo kunye namaphepha owawunikwe xa ushiye iofisi yegqirha kwaye uqiniseke ukuba ufumene ezi nkonzo. Ngokuqhelekileyo kulula ukutsho kunokuzenzela.

Ukuba nayiphi na iinkonzo zibonakala zingavamile kuwe, okanye ukuba ungabaza ukuba ngaba uwamkele, qhagamshelana nenombolo yefowuni ebonelelwe kwilwayo.

Kukho izizathu ezibini zokwenza oku:

1. Okokuqala, awufuni ukuhlawula (okanye awufuni ukuba i-inshurensi yakho ihlawule) nayiphi na inkonzo ongayifumanayo.
2. Okwesibini, ngenxa yokuba iimpazamo kwiibhili zithintela sonke imali. Kuyavunywa, usenokuba neenkonzo ezithunyelwe kwi-akhawunti yakho ngephutha. Ingaba yinto engenamsulwa. Kodwa iibhiliyoni zeedola zikhokhiswa ngokunyanisekileyo kwi-Medicare kunye nenkampani zomshuwalense ngamnye ngonyaka. Kuye kuthi ngamnye kuthi siqinisekise ukuba ababoneleli bethu abayikusihlawula ngokukhohlisa .

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Inyathelo 3 - kabini Hlola iikhowudi ze-CPT

Kwi-bill yegqirha, uza kubona ikhowudi yeefayili emihlanu emele ikhowudi ye-CPT.

Uyakhumbula ukuba iikhowudi ze-CPT zimela zonke iinkonzo umniki-zonyango onokusibonelela. Ukuba awuqinisekanga malunga nokusetyenziswa kwazo, unokufunda ngakumbi ngeekhowudi ze-CPT, apho zivela khona kwaye kutheni zibalulekile .

Kwi-bill yakho yonyango, uza kufumana iikhowudi ze-CPT ezihambelana neenkonzo. Naluphi na isihloko senkonzo siya kuba sifana, ukuba akunjalo ngokufanayo, njengokuba kuqeshwe i-AMA yale nkonzo.

Isikhumbuzo, kwakhona, ukuba iikhowudi ze-HCPCS , iNqanaba I, zifana neikhowudi ze-CPT.

Ukuba ufuna ukukhangela iikhowudi ze-CPT ukuqinisekisa ukuba zifana noluhlu lweenkonzo, unokwenza ngokukhangela kwekhowudi ye-CPT .

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Inyathelo 4 - Ukujonga iikhowudi zokuxilongwa kwe-ICD kwiBhili yakho yezoLo

Iikhowudi zokuxilonga, ezibizwa ngokuba yiikhowudi ze-ICD-9 okanye ze-ICD-10, ziya kubalwa kwakhona kwi-bill yezobisi.

Ugqirha okanye omnye umniki-mboleko akayi kuhlawulwa yinkampani yakho yomshuwalense okanye omnye umhlawuli wezempilo ngaphandle kokuba unikezela ikhowudi yokuxilonga ukuhamba kunye neenkonzo. Isizathu kukuba kuphela iinkonzo ezithile ezinokuthi zenzelwe ukuxilonga ezithile. Ngokomzekelo, ugqirha wakho akakwazanga ukuqhuba ukuhlolwa kwentliziyo ukuba ingxaki yakho yayingumlenze emlenzeni wakho.

Ezi zifo zimelelwe ngamakhowudi e-ICD (UkuBaluleka kwamaZwe ngamazwe), inguqulelo ye-9 okanye i-10. Ininzi yokuhlawula ikhoyo ibonisa iikhowudi ze-ICD-9 kodwa kwiminyaka embalwa ezayo, bonke ababonelela ngempilo baya kutshintshela kwi-ICD-10. Unokufuna ukufunda okungakumbi malunga nale khowudi yokuxilonga kunye nokutshintshwa kwizinto ezintsha.

Kwezinye iimeko, kukho iikhowudi ezininzi zokuxilonga ezisetyenziswayo, njengoko kukho kulo mzekelo. Oku kubonisa ukuba ugqirha akaqinisekanga yintoni ebangela impawu kwaye ngokuqhelekileyo ibonisa izizathu zeemvavanyo ezinikezwayo.

Unokuba nomdla ekujongeni iikhowudi ze-ICD . Lo mthetho-mali uqulethe ikhowudi ye-ICD-9 engama-785.1, emele iipilpitations zentliziyo, kunye ne-272.0 leyo ikhowudi ye-hypercholesterolemia ecocekileyo.

Kutheni ufuna ukujonga iikhowudi ze-ICD? Ukuba uye watyelela ugqirha wakho ngeempawu kwaye akaqinisekanga malunga noko akufunayo, unokufumana izikhombisi-ndlela kulezi khowudi.

Ukuba iikhowudi azenzi nto kuwe, ukuba uyazi ukuba awunayo ingxaki ebhaliweyo, ngoko unokubonisa ukuba ufumene ibhilikhwe engafanelekanga, okanye ukuba ubuqhetseba kubandakanyeka ngandlela-thile, kubandakanywa nokuba yonyango ubusela . Qhagamshelana ne-ofisi yakho yomboneleli ngokukhawuleza ukucacisa.

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Inyathelo lesi-5 - Ingaba iNkonzo yezoNyango yayininzi kangakanani?

Iimali zakho zonyango ziza kuba nelixa lakho ugqirha lihlawulwa ngeenkonzo zakhe kwilwayo.

Ngokuqinisekileyo, isizathu esilithunyelwe kuwe sisisigxina sokuba unikwe udokotela wakho okanye unomnye umboneleli wezonyango, ulungile?

Abaninzi bethu bajonge kuphela kwixabiso ngoba siyazi ukuba iindleko ziya kubhekiswa ngumgcini-mali okanye omnye umhlawuli. Njengoko bambalwa abantu bafumana i-inshurensi, okanye njengokuba sisenza ezininzi kwizicwangciso ze-inshorensi zempilo ephezulu, loo ndleko iya kubaluleka ngakumbi.

Kukho into esinokuyenza ngala manani, nangona singalindelekanga ukubhala isheke kubo. Siyakwazi ukubheka inkonzo ukuba sibone ukuba ixabiso liqikelelwa. Oku kungenziwa ngokusebenzisa ikhowudi ye-CPT kunye ne-AMA iwebhusayithi.

Ngokwenza uphando lwekhowudi nganye ye-CPT oludweliswe, unokufunda oko i-Medicare ibuyisela khona loo nkonzo. Uninzi lweenkampani zomshuwalense zilandela i-Medicare intengo efanelekileyo kakhulu. Ukuba unomshuwalense wabucala, ungalindeli ukuba amanani afanelekileyo, kodwa aya kusondela.

Ngelixa ulapho, unokufuna ukufunda ukuba kutheni umahluko phakathi kweyayilwayo yonyango kunye nento ehlawulwa ngayo yiinkampani ezizibuyisela.

Ngoku ukuba uyayiqonda indlela yokufunda ibhilikhi yezokwelapha, unokufuna ukujonga ezinye iingcambu onokuzifanisa nazo: irisidi / uluhlu lweenkonzo zakho ugqirha wakho ukunika yona, kunye ne-EOB (inkcazo yeenzuzo) kamva ufumana kumhlawuli wakho.