Ngaba utyando lwakho luya kwenza uludwe?
Kukho izinto ezininzi ofuna ukucinga ngazo ngaphambi kokuhamba phantsi kweela. Eyokuqala, ewe, ingaba utyando lwakho luyimfuneko okanye ukuba kukho ezinye iindlela zokwelapha ezikhoyo. Emva koko kuza ukusetyenziswa kweendlela kunye nokuhlinzwa kwakho kuya kwenziwa phi. Ekugqibeleni, ingaba i-inshorensi iya kuhlawulwa kangakanani kumthetho-mali?
Akufanele ufumane uphando olululo okanye inkqubo ngaphandle kokujongana nale miba ngaphambili.
Njengazo ezininzi izinto phantsi kwe-sambuli ye-Medicare, kungekhona yonke into emnyama nomhlophe. Abambalwa abantu bayazi ukuba amaziko e-Medicare kunye neMedicaid (i-CMS) iye yasungula uluhlu lwezonyango eziza kugqitywa yi-Medicare Part A ngelixa ezinye i-operesheni, ngaphandle nje kokuba kungekho ziinkathazo, ezizenzekelayo kwi-Medicare Part B. Oku kuchaphazela kuphela ubuninzi obuya kuhlawula kodwa apho utyando lwakho lwenziwa khona.
Uluhlu lwezoNyango oluPhezulu lwezoPilati kuphela
Unyaka ngamnye i-CMS ikhupha uluhlu oluthatywayo olusandul Utyando lwale luhlu alukhethiweyo ngokukhethiweyo. Ngenxa yobunzima benkqubo, umngcipheko weengxaki, i-need for monitoring post, kunye nexesha elide elilindelekileyo lokubuyiselwa, i-CMS iyaqonda ukuba le misebenzi yokudinga ifuna izinga eliphezulu lokunyamekela.
Imizekelo yezigulane zonyango kuphela ziquka:
- I-coronary artery bypass grafting (CABG)
- Ugqirha lwe-gastric ogqitywe ngokugqithisa
- Ukulungiswa kwenqwelo yevilve okanye ukutshintshwa kwevaji
Ukuze ukhuseleko lwabaxhamli be-Medicare, le misebenzi kufuneka iqhutywe esibhedlele. I-Medicare Icandelo A liquka ubuninzi beendleko zokuhlinzwa, kwaye uya kuhlawula i-deductible ($ 1,316 ngo-2017).
Ugqirha owenziwe kwiiNgqungquthela zoBugqirha
Utyando olusisigxina nje kuphela alukwazi ukuqhutyelwa kwiZiko loBugqirha lwe-Ambulatory (ASC).
Enyanisweni, i-CMS ipapasha uludwe oluthile lwezonyango zonyango ezingenziwa kwi-ASC. Olu luhlu lubizwa ngokuba yiHlomelo AA.
Ngenkcazo, i-ASC yindawo yokugulisa isigulane esipheleleyo apho unyango lwenziwa khona. Kungenzeka okanye kungabandakanywa nesibhedlele. Unokuva kwakhona ii-ASC ezibhekiselwe kuzo njengamaziko otyando-suku.
Ngokwezikhokelo ze-CMS, "iikhowudi zokugqitywa ezifakiwe kwi-ASC uluhlu lweenkqubo zokucoca ezikhuselekileyo yizo eziye zazimisela ukubeka ingozi ebalulekileyo kwi-Medicare abaxhamli xa zibonelelwa kwi-ASC kwaye ezingalindelekanga ukuba zifune ukubeka iliso olusetyenjini Phakathi kobusuku bemihla yokuqhutywa kwenkqubo yokucubungula (ukuhlala ubusuku bunye). "Kulula nje, le misebenzi yokuhlinzwa iyingozi kwaye ayilindeleke ukuba ifune ukunakekelwa kunye nokubeka iliso ngaphaya kweeyure ezingama-24.
Imizekelo yeenkqubo ezingenziwa kwi-ACS ziquka:
- Ukususwa kweCataract
- I-Colonoscopy kunye okanye ngaphandle kwe-biopsy
- Ijoyi ye Epidural ngenxa yentlungu
- Iprostate biopsy
- I-Shockwave unyango lweentso zamathambo
Ezi zonyango ziya kugqitywa yi-Medicare Part B, kwaye uza kuhlawulwa iipesenti ezingama-20 zazo zonke iindleko.
Uluhlu lweeCroperry Lists kunye noKhuseleko lweMonde
Uluhlu lwezonyango kuphela lusetyenziso lweentlawulo; Kwakhona ukhuseleko.
Abasebenzi esibhedlele bahluke kakhulu kunokuba kwi-ASC. Nangona isibhedlele sinezibonelelo zeeyure ezingama-24, i-ASC inokunciphisa abasebenzi ngexesha lobusuku. Uninzi lwe-ASC aluyi kuba nogqirha kwisayithi emva kweeyure.
Ukuba kukho inkathazo emva kweeyure, akunakwenzeka ukuba i-ASC iza kuba neendlela ezifanelekileyo kunye nabasebenzi abakhona ukuyilawula. Oku kungadinga ukuhambisa isigulane kwisibhedlele esiseduze. Ekubeni ukunyamekela kwi-ASC kunqamle ukuhlala kwiiyure ezingama-24, ukuba isigulane sidinga ixesha elide lokufumana, isiguli siya kufuneka sidluliselwe esibhedlele.
Ngenxa yezi zizathu, zonke iinkqubo zoluhlu lwe-Inpatient kuphela kufuneka zenziwe esibhedlele.
Nangona kunjalo, oko akuthethi ukuba ezinye iintlobo zonyango aziyi kuqhutywa kwisibhedlele. Ukuba utyando alukho kwiluhlu lwezonyango kuphela kwaye kungekhona kwi-AA yesongezo, kufuneka kwakhona kwenziwe esibhedlele.
Ukuthelekiswa kweMpilo yeMveli kwiMedare yeNzuzo
I-Medicare yendabuko ( iNgxenye A kunye neCandelo B ) kunye ne- Medicare Benevantage (Icandelo C) landela imithetho eyahlukileyo. Nangona i-Medicare yendabuko ilandela zonke izikhokelo zokuhlawula ezichazwe ngasentla, izicwangciso ze-Medicare Benevantage azikho. Banokukhetha ukuhlawula ukuhlinzwa njengogula okanye umhlalaphi, oko kukuthi ukuhlawula ngaphezulu okanye ngaphantsi, kungakhathaliseki ukuba kuluhlu lwabantu abanesifo. Oku kungabangela ubunzima bezemali kuwe.
Kungakhathaliseki uhlobo lwesicwangciso se-Medicare onayo, utyando lwe-Inpatient kuphela uluhlu kufuneka lwenziwa esibhedlele.
Kukho inzuzo yokufumana isicwangciso seMedare Benevantage. Cinga ngononophelo lokuvuselela emva kokuhlinzwa kwakho. Ukuze i-Medicare yendabuko ihlawule ukuhlala kwisibonelelo esinonophelo lwezonyango, kufuneka ukuba ungeniswe ubuncinane kwiintsuku ezintathu ezilandelelweyo njengesigulana. Izicwangciso ze-Medicare Benevantage zikhethwa ukuba zikhethwe ngolawulo lwemihla emithathu. Oku kungakusindisa kakhulu kwiindleko zokuvuselela ukuba ukuhlala esibhedlele kufutshane.
ILizwi
I-Medicare ayiphatha yonke into yokuhlinzwa. Uluhlu oluthile lwezonyango olusisifo sengqondo lukhutshwa rhoqo ngonyaka ngeCMS. Ezi nkqubo zivunywe ngokuzenzekelayo kwiNgxenye ye-A kwaye kufuneka zenziwe esibhedlele. Zonke ezinye iindlela zokuhlinzwa, ngokungakhathaliseki ukuba akukho zixazululo, zifakwe kwiCandelo B.
I-CMS iphinda ikhiphe iHlomelo ye-AA yonyaka ecacisa ukuba yisiphi isifo (isithuba esingenalo isifo-kuphela). Bonke abasebenzi abasecaleni bonyango kufuneka baqhutyelwe esibhedlele kunoma ubani kwi-Medicare.
Khangela ukuba yeyiphi iqela lakho inqubo yakho ewela phambi kwexesha ukwenzela ukuba ukwazi ukucwangcisa kakuhle kwaye ukhuphe uxinzelelo olongezelelweyo.
> Imithombo:
> Amaziko okuPhengisa izilwanyana. Amaziko e-Medicare kunye neeNkonzo zeMedicaid. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Ukuhlaziywa kwe-Oktobha 20, 2016.
> Umgaqo-nkqubo weeNkcazo weMithethonqubo kaRhulumente: Isihloko 42 - Isahluko IV - I-Subchapter B - Icandelo 416: IiNkonzo zokuPhepha ezixilisayo. Iofisi yoRhuculo kaRhulumente wase-US. https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=38af2161b33de70fc35286fdbee57ca6&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#PartTop. Ukuhlaziywa kwe-Oktobha 12, 2017.
> I-FY 2017 IPhasi lokugqibela le-IPPS. Amaziko e-Medicare kunye neeNkonzo zeMedicaid. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html. Ukuhlaziywa kweyoMatshi 7, 2017.
> Inkqubo yeMicrosoft: Isibhedlele esibhedlele Isibonelelo sokuhlawula kunye ne-Ambulatory Center Centre yokuThengisa iiNkqubo zoThutho kunye neMigangatho yokuBela ingxelo. Register Register. https://www.federalregister.gov/documents/2017/07/20/2017-14883/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment. Ipapashwe ngoJulayi 20, 2017.