Iingcamango zomthetho zibandakanya ukuqonda nokulandela imimiselo yelizwe kunye nemimiselo. Indawo esoloko iyona nkxalabo yinto yokukhwabanisa kunye nokuxhatshazwa ngokukodwa malunga ne-Medicare, Medicaid, kunye nezinye iinkqubo ezixhaswa ngemali.
Imiba yokuziphatha iquka ukuqonda nokulandela izikhokelo zoshishino nezempilo. Ngamanye amaxesha imiba yokuziphatha iyabonwa njengemicimbi esemthethweni. Uninzi lwemigaqo-nkqubo yokuthobela i-ofisi iquka iinkalo zomgaqo-mthethweni nezomthetho.
Iingxaki zoLuntu
Ilungelo elibaluleke kakhulu isigulane unelungelo lokufumana imvume. Isigulane sifanele sivume kuphela unyango lwezempilo ukuba lunolwazi olwaneleyo malunga nokuxilongwa kwazo kunye naluphi ukhetho olwenziwe ngolu hlobo.
Kukho ezinye ezisixhenxe ezinye amalungelo ogulane:
- Ulwazi olunomonde
- Ukhetho lwababoneleli
- Ukufikelela kwiinkonzo eziphuthumayo
- Ukuhlonipha kunye nokungacaluli
- Imfihlo
- Izikhalazo kunye nezibheno
- Uxanduva lwezonyango
Ukunyaniseka kunye neengxaki zoxhatshazo
Ukukhwabanisa ngokuqhelekileyo kubhekisela kumabango ezonyango ngokuzenzekelayo nangokweqabileyo ngenzame yokukhwabanisa nayiphina inkqubo exhaswa ngemali ngemali.
Iindlela eziqhelekileyo zobuqhetseba nokusetyenziswa kakubi zibandakanya ukuhlawula izixhobo ezingakhange zinikezelwe, ukuhlawulwa kweenkonzo ezingazange zenziwe, iindleko zokubhalwa kwee-up-up zokufumana ixabiso lokubuyisela phezulu, nokuhlawula iindleko.
Iinkqubo zokuQala
I-Credentialing yindlela enye i-insurers ikhusela izigulane zabo kubaboneleli abangenayo i-unlicensed providers. Ukubambisana nabathwali bomshuwalense yinkqubo ebalulekileyo kwiofisi yezobugcisa. Oogqirha kunye nabanye abaqeqeshi kufuneka banikele uluhlu lweengcaciso kubathwali bomshuwalense, kuquka ne-Medicare kunye neMedicaid, ukuze bakwazi ukufumana iindleko zokubuyiselwa.
Iziphumo zokungafumani i-credentialing ezifanelekileyo zingakhokelela kwimali elahlekileyo. Abathwali be-inshurensi abayi kubuyiselwa nayiphi na iofisi yezobugqirha ukuba iinqununu zabaqeqeshi okanye iinkonzo ezinikezelwa ngabaqeqeshi abangakhange baqinisekiswe ngokufanelekileyo.
Iinkqubo zoKhuseleko lweMichiza kunye neNkqubo yokuQaphela
Iinkcukacha kufuneka zithunyelwe kubasebenzi bee-medical office malunga neendlela zokukhusela ezifanelekileyo zokusetyenziswa, ukugcinwa nokulahlwa kwazo zonke izinto eziyingozi.
- Isixhobo soKhuselo esiMntu (i-PPE): Oku kufaka izikhuselo zokukhusela, iiglavu ezifanelekileyo kunye neengubo zelabhu.
- Ukubhaliweyo okufanelekileyo: Izinto eziyingozi mazize zifakwe kwisitya esingenakubhalwe. Zonke izixhobo kufuneka zifakwe kwiSikhwama seNkcukacha zoKhuseleko (MSDS) kwaye mazihlaziye rhoqo.
- Landela Izikhokelo Zabavelisi: Sebenzisa indlela efanelekileyo yokulahla, uqhagamshelana namehlo okanye isikhumba, okanye utyhala.
UkuLahlwa ngokufanelekileyo kweNgcaciso yoMguli
Naliphina indawo echazwe yi-HIPAA njengenhlangano ekhuselekileyo inexanduva lokuqinisekisa ubumfihlo kunye nokukhuselwa kolwazi lomguli kunye nokugcina imfihlo ye-PHI yabo. Ukulahlwa ngokufanelekileyo kolwazi lwezempilo olukhuselekile (PHI) kunye nolunye ulwazi oluyimfihlo nokuba iphepha okanye ifomathi ye-elektroniki iyimfuneko ye-HIPAA.
Ingozi yokuLawulwa kweNkunkuma kunye nokuKhusela
Nangona kungekho ndlela eyi-100% yokungaziphathi kakubi naluphi na uxanduva lwezokwelapha, zikho iindlela zokunciphisa amathuba okuba ufikelele ekupheleni komvuzo.
Ukwahlukana kunye neNkcubeko
Ulwahlulo luzungezile kodwa imibutho eninzi ifumana inzima ukubandakanya ukuhlukahluka kwimizi ngemihla. Kwimimandla yanamhlanje, iofisi yezobugcisa kufuneka ifake ukuhlukahluka kwintsebenzo, umbono, kunye nemilinganiselo ukwenzela ukubonelela ngononophelo lwegulane kunye nokuphatha kakuhle abasebenzi.
Ukuqonda ukuhlukahluka kuthetha ukuqonda iintlukwano ngaphandle kwezizathu ezicacileyo ezifana nobuhlanga, ulwimi kunye nesini. Ukwahlukahluka kubhekisela kuyo yonke into malunga nabantu abenza ukubahluke kubandakanye iindlela zokusebenza, ukuziphatha kunye nexabiso, imfundo kunye noqhagamshelwano.
Imigaqo-akhawunti
I-General Accepted Accounting Principles (GAAP) yimiqathango eqhelekileyo yemigaqo-nkqubo yemigangatho, imigangatho, kunye neenkqubo iinkampani ezizisebenzisayo ukuqokelela iingxelo zabo zezimali. I-GAAP, ukubeka nje, iindlela ezamkelweyo ngokuqhelekileyo zokurekhoda nokunika ingxelo yengxelo yemali.
Inhlangano nganye inokusebenza ngokuhlukileyo kodwa bonke kufuneka balandele izikhokelo ezisetyenziswe kwintlalo yombutho, kwilizwe nakwinqanaba lezemfundo. Ukuba le migangatho neenkqubo azilandelwa kwiKomishoni yezokuThuthukiswa nokuTshintshiselwa kwe-US (i-SEC) iya kulungelelanisa umbutho kwaye mhlawumbi ilandele isenzo solwaphulo-mthetho ukunyanzelisa ukuthotyelwa.