Ngokutsho kwe-CMS, amabango angaphezu kwezigidi ezi-5 zonyango zithunyelwa ngenkokhelo ngamnye ngonyaka. Ukubhaliweyo kwekhowudi kubalulekile ukuqinisekisa ukuba la mabango aqhutyelwa ngendlela ehambelanayo. Iinkampani zomshuwalense, abahlawuli bezithathu, kunye nemimiselo yomgaqo-karhulumente baye babonisa inkxalabo ekhulayo malunga nokubaluleka kweenkcukacha ezichanekileyo kwiinkonzo zonyango.
Xa ababoneleli behluleka ukuthobela iimfuno zokunikwa kweemfuneko ezifunekayo kwiinkqubo zokugqithiswa kweemali, ithuba lokuhlawula okungafanelekanga linyuka.
I-Medicare isebenzisa i-PPS (Inkqubo Yokuhlawula Iinjongo) kunye needyuli zemirhumo ezisebenzisa indlela yokubuyisela esekelwe kwisixa esicwangcisiweyo. Kukho ii-PPS kunye neehedyuli zemirhumo ezisekelwe kwiinkonzo ezibonelelwe.
Iinkqubo zokuTyala eziPhambili
- Izibhedlele ezigulane
- Asekhaya zempilo arhente
- Hospice
- Isibhedlele
- Izibonelelo zengqondo zonyango
- Izibonelelo zokuphucula izifo
- Izibhedlele zexesha elide
- Iziko lononophelo
Iishedyuli zeeRhafu
- Oogqirha
- Iinkonzo ze-ambulance
- Iinkonzo zebhubhoratri zonyango
- Izixhobo zonyango ezizinzileyo, ii-prosthetics, orthotics, kunye nempahla
Ngaphantsi kweShedyuli ye-PPS kunye neeRhafu, umniki ngamnye uya kubuyiselwa imali echazwe ngaphambili esekelwe kwikhowudi yenqubo echaziweyo. Ukukhokhwa okungahambi kakuhle kungabangela ukungaphumeleli ukuthobela iimfuno zekhowudi.
Kukho iindawo ezilishumi ezidibaniswa neenkqubo ezingenakulungiswa zezigulane.
- Ukubika iiyunithi zenkonzo ezingalunganga
- Inkokhelo engafanelekanga kwiinkonzo zokujonga
- Ukubika iindleko ezingalunganga ngenxa yeenkcazelo zexesha lexesha elikhoyo
- Ukuhambisa iincindi zerhafu okanye ukungaphumeleli ukulandela iNCCI (Isizwe sokuCoding Initiative Initiative) isikhokelo seMediare kunye neMedicaid
- Ukunika ingxelo engafanelekanga yenkqubo yokuguqula ikhowudi
- Ulungelelaniso lwe- E / M (Uvavanyo kunye noLawulo) ukhetho lwekhowudi
- Ukubika "inkqubo yokugulisa isigulane" kuphela kwisibango sokugula
- Ukuhambisa amabango kwiinkonzo ezingekho mfuneko
- Ukungaphumeleli ukulandela imithetho emininzi yokuphuhlisa
- IiNkonzo ezibonelelwe ngumfundi, umhlali okanye omnye umqeqeshi ngesimo esingavunyelwanga ngaphandle komphathi wesigqeba
Iiphoso zokudibanisa zingabandakanywa kwizinto eziliqela.
- Iingcinezelo zexesha kunye / okanye ukuthintela
- Iziphazamiso
- Ukungabi namava okubhala
- Iphutha lomntu
- Ukungabi nxibelelwano
- Iziganeko ezidibeneyo zesigulane
Ezi zinto zivame ukungabi nentsingiselo kodwa xa iziphene zekhowudi zenzeke ngokungqinelanayo, ababoneleli bangaqwalaselwa ngokuphula uMthetho woBangqina bamanga ngenxa yokuziphatha okuhlawulayo. Ukhohlisayo maxa wambi udideka kunye nokusetyenziswa kakubi. Ukusetyenziswa kakubi kukuhlawula ngokungazenzisiyo izinto okanye iinkonzo ezingenakunikwa. Ezi ndawo ezine eziqhelekileyo ezichongiweyo njengeNkohliso okanye ukuShatshazwa:
- Ukuhlawula izixhobo zonyango akuzange zinikezelwe
Ummandla oqhelekileyo we-Medicare ubuqhetseba yi-Billing ye-Medical Durable Equipment (DME). I-DME ibhekisela nasiphi na izixhobo zonyango eziyimfuneko kwisigulane okanye kwisimo somzimba. Iquka izihlalo zamasondo, izibhedlele zesibhedlele kunye nezinye izixhobo zolu hlobo. Umboneleli uya kuhlawula i-Medicare kwisixhobo esiye safumana isiguli. Abaqhubi bee-Mobility baye bathandwa kakhulu kwiinkqubo zobuqhetseba ze-Medicare.
- Uhlawulo lweeNkonzo ezingakaze zenziwe
Kule meko, umniki-mboleko owenzela iimvavanyo, unyango okanye iinkqubo azange zenziwe. Oku kungongezwa kwoluhlu lweemvavanyo isiguli esifumene kwaye asizange siphawule. Umboneleli angaphinda akhohlise iikhowudi zokuxilonga ukuze afake iimvavanyo okanye iinkonzo ezingadingekile.
- Iintlawulo zokuhlawula
Ukungafani kakuhle nenqanaba lenkonzo okanye inkqubo eyenziweyo ukwenzela ukuhlawulisa ngaphezulu okanye ukufumana isantya sokubuyiselwa esiphezulu kuthathwa njenge-coding. Ukugqithisa kwakhona kuyenzeka xa inkonzo eyenziweyo ingagqitywa yi-Medicare kodwa iindleko zeenkonzo ezikhuselekileyo kwiindawo zayo.
- Iingxowa Zokudiliza
Ezinye iinkonzo zibhekwa njengento yonke. Ukuqhawula ukuhlawulela i-billing kwiinkqubo ngokwahlukileyo ezihlawulwa ngokuqhelekileyo njengentlawulo enye. Ngokomzekelo, umniki-mboleko wonikezelo lwezilwanyana ezimbini zokungcebelekanga, endaweni yokuhlawula i-1 yokuhlaziya i-mammogram.
Amabango okuqhafaza ngokuchanekileyo avumele ukuba umntu ohlawula i-inshorensi azi iimpawu, ukugula okanye ukulimala kwesigulane kunye nendlela yokonyango eyenziwa ngugqirha. Iiposiso zeCoding zenzeka xa ibango lingeniswa kwikhampani yomshuwalense enexilongo engafanelekanga okanye ikhowudi yenqubo kwibango. Ukungena ngokungekho kakuhle kungakhokelela kwiziphumo ezininzi ezingalunganga. Kubalulekile ukuba iofisi yezobugcisa ivelise inkqubo yokuthobela inokuthintela ukuphulwa kweemfuno zokunikwa kwezokwelapha.