Inkokhelo yokubambisa i-inshurensi incike ekuchanekeni kwekhowudi yezokwelapha
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.
Ukugwetywa kwezibango zonyango yinkqubo esetyenzisiwe ngabatshutshisi ukuba bahlole i-coding kwaye banqume ukuba ngaba inkqubo iya kuhlawulwa, inqatshelwe okanye iyancishiswa.
Ukuba kukho impazamo yokwenza ikhowudi, inokubangela ukuba ibango liphiwe. Ukuxilongwa okanye inkqubo ehlawulweyo ayinakugqitywa yinkqubo yomshuwalense, okanye inokuthi ikhutshwe kancane, nangona yayigunyaziwe ngaphambili
Ngenxa yoko, umniki-mboleko akanakho ukuhlawulwa ngokugcwele kwinkonzo enikezelweyo, okanye isigulane sinokungalindelekanga ukuba uxanduva lokuhlawula iinkonzo ngaphandle kwepokothini.
Iingozi ze-Overcoding ne-Undercoding
Kukho nokuba nemiphumo yomthetho kunye nemali yekhowudi yezokwelapha ezingachanekanga. Ukugqithisa iikhowudi zokunika ingxelo ngendlela ekhokelela ekuhlawuleni okuphezulu kwi-insurer. Oku kungathathwa njengokukhwabanisa nokukhokelela ekutshutshisweni, kunye nezohlwayo zomthetho nezemali.
Ingxaki echaseneyo i-undercoding, ingabandakanyi iikhowudi zazo zonke iinkqubo ezenziwe okanye zibhalwe kwiinkqubo ezibuyiselwa kwizinga eliphantsi. Oku kukhokelela kwingeniso elahlekileyo kumboneleli.
Iinkcukacha ezisisiseko ezibalulekileyo ezifunekayo kwiimangalo zamakhowudi zi-ICD (Ulwahlulo lwaMazwe ngamazwe lweZifo) iinkcukacha zenye enye ezibizwa ngokuba yiikhowudi zokuxilonga.
Ukuxilongwa kunye neNkqubo zeeNkcukacha
Iikhowudi zokuxilonga zisetyenziselwa ukuchaza ukuxilongwa, impawu, imeko, ingxaki okanye isikhalazo ezinxulumene nokunyangwa kwesigulane.
Ukufumanisa i-diagnosti kufuneka ifakwe kwikheyithi ephakamileyo yokutyelela.
Ngokuqhelekileyo, iikhowudi ze-ICD zisetyenziswa kunye ne-HCPCS (Iinkqubo zeCoding Process Coding System). 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 iikhowudi ezinamanani e-alfabhethi enee-alfabhethi enye elandelwa ngamanani amane kwaye ilawulwa yi-Centres ye-Medicare neMicroid Services (CMS). Ezi khowudi zichonga iinkonzo ezingezizo ugqirha ezifana neenkonzo ze-ambulensi, izixhobo zonyango ezizinzileyo kunye nekhemisi.
- Iikhowudi zeNqanaba III zikhowudi zee-alphanumeric W, X, Y, okanye Z ezilandelwa ngekhowudi yeenombolo ezine. Ngenye indlela eyaziwa njengeikhowudi zendawo, ezi khowudi zisetyenzisiweyo njengekhowudi eyahlukileyo xa kungekho nqanaba I okanye ikhowudi ye-II ukuyichonga.
Iikhowudi eziyinkimbinkimbi kakhulu yi-DRG's (I-Diagnosis Related Groups). Ii-DRG zidibanisa:
- Ukuxilongwa
- Iinkqubo
- Iingxaki
- Iimpawu
- Imiqathango ekhoyo ngaphambili
- Ubudala kunye nesini
Ii-DRG zisetyenziselwa ukukhuphela iimfuno zamatyala. Abaninzi batshorensi bahlawula ngokwe-DRG, ngoko ke, ukuchaneka kwazo zonke izixhobo kubalulekile ekuhlawuleni ibango elifanelekileyo.
Ibango elichanekileyo lixhomekeke kwizinto ezininzi. Ukuhlala ufikelele kwiinguqulelo zonyaka zokulandela ikhowudi, ukulandela izikhokelo zokugcina iinkcukacha kunye nokugcina iirekhodi ezigulane eziqhelekileyo ziindlela ezilula zokuqinisekisa ukuba iimfuno zonyango zichanekile.