Qaphela lo Msebenzi okhohlisayo kunye neNdleko
Ukukhutshwa kwe-coding kuyinto yokukhokhiswa yonyango yonyango esithintela yonke imali kunye nempilo. Ithekisela kumsebenzi apho umniki-mali ehlawula umboleki-mali (nokuba ngumntu ozimeleyo, uMedicaid okanye iMedareri ) usebenzisa ikhowudi ye- CPT yeenkonzo ezininzi kunokuba zenziwe.
Ukukhishwa kweekhowudi kungekho mthethweni. Inkqubo yobuqhetseba esetyenziswe ngababoneleli abazama ukukopela inkqubo ukwenzela ukuba baya kuhlawulwa imali ngaphezu kokuba baxoxisane nalabo bahlawula.
Kubiza kakhulu izigulane ngamnye kunye nabahlawuli berhafu.
Ukuqhubela phambili, ukukhutshwa kwe-coding kunokuba neempembelelo zempilo ezingalunganga kwizigulane. Ibeka ulwazi olubuxoki kwiirekhodi zabo zonyango kwaye lunokuchaphazela ukukwazi ukufumana i-inshorensi.
Ukukhutshwa kweenkcukacha kwiinkcukacha ezingakumbi
Inkqubo nganye eyenziwa ngugqirha okanye omnye umboneleli wezempilo unomgaqo oqhotyoshelwe kuyo ovumela ukuba bahlawule i-inshurensi yakho, iMicicaid okanye iMedareri, okanye nabani na umhlawuli-mhlawumbi nokuba nguwe, isiguli. Le khowudi ibizwa ngokuba yikhowudi ye-CPT, ejonge kwiNkcazo yeNkqubo yangoku.
Xa ugqirha wakho ethunyelwa ikhowudi kumhlawuli wakho, loo khowudi ye-CPT inquma ukuba uya kuhlawulwa kangakanani. Iimpawu ezahlukeneyo zihambelana nenkqubo ezahlukeneyo okanye iinkonzo kwaye zinokuba neendleko eziphezulu okanye eziphantsi. Ngethuba nje umniki-benzisi esebenzisa ikhowudi echanekileyo, umniki-ntlawulo uyahlawulwa ngokusekelwe kwiinkonzo kunye neenkqubo ezenziwe.
Xa umniki-mboleko ephakamisa, ke, banikezela ikhowudi yeenkonzo ezithe xaxa okanye iinkqubo kunokuba zenziwe.
Imizekelo yokuPhakamisa
- Umzekelo 1: Utyelele ugqirha wakho ngokukhawuleza. Ikhowudi yale tyelelo ibonisa ukuba iya kuhlawulwa i-$ 50. Kodwa, ukuba ugqirha unikezela ikhowudi ye-CPT yokwandisa isheke, uya kuhlawulwa i-$ 100.
- Umzekelo 2: UDkt. Cheater uxilonga uMnu. Smith ngomlenze ophukile. UNksz Smith "uyaphula" kuphela ukuphulwa kweenwele. UDkt Cheater umxelela ukuba alumke aze asebenzise iinqonga zokuhlala emlenzeni weeveki ezimbalwa.
Nangona kunjalo, xa uDkt Cheater ehambisa isigxina kwi-Medicare kuMnxeba kaMnumzane Smith ophukile, ungena kwi-CPT ikhowudi ebonisa ukuba ubeka umlenze wakhe entolongweni, kwaye kamva uhambisa ibhilikhwe yokususa ezo zinto-zombini iinkonzo ezihlawula ngaphezulu kunokuba wenza ngokwenene ukunyamekela uNksz Smith, usebenzisa iikhowudi ezahlukeneyo kwi-inshurensi yakhe yezo nkonzo.
Ukukhutshwa kwe-Coding kungaba nemiphumo emibi kwimpilo yakho
Ukukhutshwa komsindo kunokuba nemiphumo emibi kwiinkathalo zakho zekamva kunye nekamva lakho lokufumana i-inshorensi yempilo, kuxhomekeke kwikhowudi ogqirha ngayo.
Ngokomzekelo, cinga ukuba unayo into evakalelwa njengeentliziyo zentliziyo. Ugqirha wakho angasebenzisa i-EKG kwaye ufumanisa ukuba awukho ingxaki ngentliziyo yakho. Uhamba, ukhululiwe. Nangona kunjalo, ugqirha wakho ugqirha kwi-EKG, kodwa kwaye uhamba kunye neentengiso zakho njengentlanganiso yesigulane sentliziyo, ezisa imali engaphezulu. Ngoku iirekhodi zakho zonyango zibonisa ukuba unokuba nengxaki ngentliziyo yakho-akunjalo.
Izonyango zakho zexesha elizayo zingatshintshiswa ngenxa yokuba irekhodi lakho libonisa ukuba ungumntu onengxaki yentliziyo. Omnye ugqirha unokumisela iiliti ngokungafaniyo, okanye ukuba ubonakalisa kwi- ER , banokukuphatha ngokuhlukileyo. Awuyi kufumana unyango olufanelekileyo kuba iirekhodi zakho ziphosakeleyo.
Ukongeza, uthi ulahlekelwe ngumsebenzi wakho wangoku kwaye ufumanisa ukuba ufuna ukufumana inshorensi yempilo kamva. Okwangoku awukwazi ukuguqulwa ukuba ube nemeko esele ikhona phantsi koMthetho woNonophelo ongenakuncedo , kodwa i-inshorensi yakho ngoku iyakuthi ihlawule imali engaphezulu.
Kubalulekile ukuba izigulane zithathe ulawulo lwamarekhodi ethu zonyango ngokuphindaphinda kabini iimpazamo.
Ukugqithiswa kakubi kungekho mthethweni kwaye kuhlawula imali
Ukukhutshwa kweekhowudi kungekho mthethweni kwaye kukukhohlisa . Naliphi na umniki-mboleko onika ngenjongo yokuphula umthetho.
Njengezigulane, sinokucinga ukuba akunandaba nathi kuba ngumshuwalense ohlawulayo. Nangona kunjalo, iindleko zokuhlaziya iindleko zethu sonke imali, kubini abahlawuli berhafu kunye nabahlawuli beprayimenti.
Xa isigulane seMedare okanye iMedicaid siphetshiwe, iindleko zale nkqubo zentlalo zanda kwaye sonke sihlawula ngerhafu.
Ukuba i-inshurensi yabucala ifumana i-bill ye-billcoded, i-premium iyakhuphukela kuwo wonke umntu onayo inshuwalense . Omnye umniki-mgca wokuhlawula umxhasi angasihlawula zonke izigidi zeedola ngokuhamba kwexesha.
Yintoni ongayenza Ukuba Usola ukuhlaziya i-Coding
Ukuba uhlola i- Estimate Benefits (EOB) kwaye ukholelwa ukuba ugqirha wakho unetyala lokukhutshwa kwe-coding, kukho amanyathelo athathathweyo ukuqinisekisa ukuba umhlawuli wakho akakhokhelwa ngobuqhetseba.
- Okokuqala, qhagamshelana nomboneleli wakho uze ubuze malunga nalo. Banokukuchazela ukuba kutheni oku kuchanekileyo, okanye banokuthi bayilungise. Kukho nawuphi na umzekelo, kuya kukubeka kwisaziso ukuba kufuneka uqhubeke uhlola i-EOB yakho ngexesha ngalinye lifika.
- Ukuba awukwaneliswa yimpendulo, kwaye nangona bazinikele ukukulungisa, uya kufuna ukujonga ii-EOB zangaphambili ukuze ubone ukuba unako ukufumanisa indlela yokukhangela.
- Ukuba ukrokrela ukuba umniki-mboleko wakho uhlahlela rhoqo, uya kufuna ukuyibika kumhlawuli wakho ngokukhawuleza. Ukuba loo mniki-mboleko uye wakhupha umnakekelo wakho ngaphezu kweyodwa, ngoko uyenzele kwabanye, naye.
Ukuba umhlawuli wakho ngumshuwalense wabucala, bhekisela umnxeba ngomntu wesevisi kwaye umbuze ukuba ubani omele ubike ingxelo yokukhwabanisa.
Ukuba ufumana i-Medicaid, kufuneka uhlole i-ofisi yakho ye-Medicaid ofisi ukuze ubone indlela abafuna ukukhutshwa ngayo okanye ukukhwabanisa.
Ukuba umhlawuli wakho ngu-Medicare, uya kufumana amanyathelo okubika ubuqhetseba, kuquka ukukhutshwa kwe-khowudi, kwiwebhusayithi ye-Medicare.