Ukuqonda nge-Diem, NgeNgqikithi, ukuThuthukiswa, kunye ne-Fee-for-Service
Inshshurensi yonyango ihlawula ababoneleli ngeendlela ezine ezahlukeneyo. Ukuqonda iindlela ezahlukeneyo zokuhlawula kubalulekile ekuphathweni kwezezimali kwiofisi yezobisi . Ezi zifanele ziqwalaselwe xa kuphuhliswa isicwangciso solawulo lwezemali.
- I-Di Diem / Iintlawulo zokuTyelela
- Iintlawulo zengqungquthela
- Iintlawulo zentlawulo
- Iintlawulo zeeNkonzo
I-Di Diem kunye neNtlawulo yeTyelelo
Intlawulo ye-inshorensi eyenziwe kwiofisi yezokwelapha nganye ngosuku okanye ukutyelela yi-diem nganye okanye intlawulo nganye yokutyelela. Ukuhlawulwa kweentlawulo zenziwa ngokusekelwe kwisixa esinqunywe ngaphambili kungakhathaliseki ukuba ixesha elichithwe ngugqirha unika unyango okanye uluhlu lweenkonzo ezifumana isigulane ngexesha lokutyelela.
Ukutyelela izibhedlele zezibhedlele kunye nezibonelelo zononophelo abanezakhono ziyimimangaliso yeziganeko ezinokuba zifanelekile ukufumana iintlawulo zemihla ngemihla ngokwemvumelwano.
Iintlawulo ezijongene nazo zihlala zihlawulwa kwikliniki, impilo yekhaya, unyango lomzimba, okanye isilathiso sokugula.
I-Per-episode okanye Iintlawulo zeNtlawulo zeNkundla
Iintlawulo zengqungquthela zenzelwe zonke iinkonzo ezinikezelwa ngexesha elilodwa lenkathalo. Ziyakuthi zithathwe njengamaxabiso enkundla. Ingqungquthela yokunyamekela inokunyuka kwiintsuku eziliqela okanye ukutyelelwa kwaye ihlawulwe ngentlawulo enye.
Iintlawulo zengqameko zivame ukuhanjelwa kwiindwendwe zezithuba eziphuthumayo, iinkqubo zokugonywa kwezibhedlele, okanye ukutyelelwa kwezibhedlele. Xa zisetyenziselwa ukutyelelwa esibhedlele, ukuhlawula kudla ngokusekelwe kwi- DRG (i-Diagnosis Related Groups).
Ii-DRG zinikezwa udidi olusekelwe kwiinkcukacha zokuxilongwa kwe-ICD-9, iikhowudi ze-CPT kunye ne-HCPCS, iingxaki okanye iimeko ezikhoyo ekungenisweni, imeko yokukhutshwa, ubudala kunye nesondo. Iintlawulo ze-DRG nazo zisekwe kwixesha elithile, elilingana nenani leentsuku eziyimfuneko ukuze unyango olwaneleyo.
Ngomonde okanye Iintlawulo zokuPhupha
Iintlawulo zemiqathango yesigulane, okanye iintlawulo ze-caption, zizinzileyo, iintlawulo zenyanga zifunyenwe yi-ofisi yezobugulane kwisigulane. Eli nani lihlala lifana naluphi na ukutyelelwa kwesigulane okanye iindleko zendleko ezithathiweyo kwaye nangona bengenakunyamekelwa nonke.
Iiprogram ze- State Medicaid ngumzekelo womhlawuleli owenza iintlawulo zomguli ngamnye. Oogqirha bahlawulwa isamba esisetyenzisiweyo kwisigulane ngasinye seMedicaid banikela iinkonzo kubantu ababhalisile kwikliniki okanye ukuqhuba. Le yindlela efanelekileyo kakhulu yokunciphisa iindleko zonyango ngelixa kukhuthaza ukunakekelwa kokuthintela.
Iintlawulo zeeNkonzo
Indlela eqhelekileyo yokuhlawula iyimodeli yentlawulo-yenkonzo. Ngomrhumo-wenkonzo, iofisi yezobugcisa ihlawulwa isamba esisetyenzisiweyo nganye kwifom okanye iseyunithi yenkonzo enikwe. Ukutyelela iofisi, iimvavanyo zelabhu, i- x-ray okanye enye inkonzo inokuhlawulwa ngokwemivuzo yeshedyuli. Ukunyamekela isigulane esifumanayo, kukho iintlawulo ezininzi.
Le ndlela yokuhlawula ivumela iofisi yezobugqirha ukuba ifumane ukuhlawulelwa okuphezulu kwiqendu ngalinye lokunyamekela.
Ulawulo lwezeMali kunye neeAkhawunti ezifumanekayo
Ulawulo lwezemali lulawulo olusebenzayo nolunempumelelo lwemali eyenziwe yintlangano equka zonke iinqununu zomjikelezo weengeniso kubandakanywa neakhawunti ezifunyenweyo.
Iimali ezifumanekayo, ezibizwa ngokuba yi-accounting account, zibhekiselele kwimali engenayo eyakhiweyo kodwa ingaqokelelwanga. Ukuqinisekisa ukuhamba kwemali kukwanele ukuphathwa okufanelekileyo, i-ofisi yezobugcisa inexanduva lokunyusa i-revenue revenue potential.
Iofisi yonyango inokufumana iintlawulo ze-inshorensi nayiphi na okanye zonke iindlela ezahlukeneyo. Ukukhetha ukuba ngabaphi abatshutshisi abasebenzisana nabo banokukhetha ukuba luhlobo luni lweentlawulo eziya kufumana iofisi.