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.
Ukubhaliswa kwamabango e-Medicare unemfuno ekhethekileyo yeemfuno ababoneleli abanokubhenela ukukhusela ukukhanyela okungafaniyo kunye neentlawulo ezingafanelekanga.
Le setethi yeemfuno zekhowudi ibizwa ngokuba yiNCCI okanye i-CCI nkqubo yeenkonzo zeMedare.
I-National Coding Initiative Initiative (NCCI) yaphuhliswa ngamaziko e-Medicare kunye neeNkonzo zeMedicaid (CMS) ukukhusela iintlawulo ezingafanelekanga ze-Medicare ngenxa yokuphulwa kweefayile.
Kukho iintlobo ezintathu ze-NCCI ezihleliweyo:
- Ukulungiswa kwenkqubo-nkqubo-nkqubo
- Ukuguqulwa komzimba kungekudala
- Ukongezwa kwekhodi yokongeza
Ngokutsho kwe-CMS, i-NCCI imigaqo-coding policy iyanqunywa kwaye isekelwe kumdibaniso wemigaqo-nkqubo yeenkcukacha ezahlukeneyo kuquka:
- Inkqubo ye-Current Procedural Terminology (CPT) ye-American Medical Association (AMA)
- Imigaqo-nkqubo yeNgingqi kunye neyeMpilo
- Izikhokelo zelizwe
- Iinkqubo zempilo eziqhelekileyo
- Iikhowudi zamakhowudi zangoku
Iwebhusayithi ye-CMS inikezela inani lezinto ezibonelela kubanikeli ngenjongo yokuchaneka ngokuchanekileyo kunye nekhowudi yezobango.
- I-National Correct Initiative Coding Initiative Policy Manual yeeNkonzo zeMedare
- I-NCCI iguqulwe ukusetyenziswa kwamagqwetha
- I-NCCI iguqulwe ukusetshenziswa kwezicelo zesibhedlele esibhedlele kwi-Outpatient Code Editor (OCE)
- I-NCCI Imibuzo ebuzwa rhoqo (FAQ)
- UKUHLOLA
- MUE Imibuzo ebuzwa rhoqo (FAQ)
- Iikhowudi ze-HCPCS / CPT kunye nezindleko ezipapashwe nge-MUE kwi-table ye-MUE ye-Practitioner / DME
- Iikhowudi ze-HCPCS / CPT kunye nezindleko ezipapashiweyo ze-MUE kwiShedyuli zeeNkonzo zoPhulo lweZibhedlele
- Iikhowudi ze-HCPCS / CPT kunye nezindleko ezipapashwe nge-MUE kwiiNkonzo zonyango ezizinzileyo (DME) Iinkonzo zeeNkonzo zeMUE
- Izinguqulelo zekhompyutheni zangoku zekota ze-NCCI ziguqulwe kwaye zashicilelwa i-MUEs
- I-Medicare Learning Network Ukupapashwa: "IiNkqubo zokuHlola iziTyalo zeMatriki: MR, i-NCCI i-Edits, i-MUEs, i-CERT, ne-Recovery Audit Programme"
- I-Medicare Learning Network Ukupapashwa: "Indlela yokuSebenzisa iNkqubo yeCoding Coding Initiative (NCCI) Izixhobo"
I-NCCI: I-Procedure-to-Procedure Edits
I-NCCI inkqubo yokulungiselela inkqubo iya kusebenza kwiikhowudi zombini ze-CPT kunye ne-HCPCS.
Iikhowudi ze-CPT ziNkqubo zeNkqubo eziqhelekileyo kwaye zaphuhliswa kwaye zenziwa nguMerika Medical Association ngo-1966. Le yinkqubo yeendlela ezinhlanu zeefayili ze-alphanumeric ezichaza ngendlela echanekileyo yonyango, iinkonzo zokugqirha kunye nokuxilonga.
I-HCPCS okanye iNkqubo yeCoding System yeCoding System I-II. Inqanaba ndiqulethe iikhowudi ze-CPT, kunye neNqanaba II kubandakanya iikhowudi zeefayili ezisetyenziselwa ukuchonga iimveliso, ukubonelela kunye neenkonzo ezingabandakanyi kwiikhowudi ze-CPT xa zisetyenziswe ngaphandle kweofisi yonyango.
Inkqubo ye-NCCI yokulungiswa kwenkqubo ikhusela ukunika ingxelo kunye nokuhlawulwa kweenkonzo ezingenakuhlawulwa kwiibango ndawonye. Ukulungiswa kwe-NCCI kufumaneka kwiibhile ezine ezibonelelwe kwiwebsite yeCMS.
Ezi tafile zibhekiselele kwizibhedlele kunye namagqirha ukuba achaze iiseti zeekhowudi ezingenako ukungeniswa kwibango elifanayo okanye zidibeneyo. Ukuba ibango linamakhowudi amabini, kukho iindlela ezimbini ezinokuthi zenzeke:
- Ngokusekelwe ekubeni ingaba ikhowudi ibhalwe kwikholam 1 okanye ikholamu 2 yetafile, ikhowudi yekholamu 2 iya kukhanyela. Umzekelo: Umniki-mboleko akafanelekanga ingxelo yezilwanyana ezixilongwa ngokungaxilwanga kunye ne-diagnostic mammogram. I-unilateral diagnostic mammogram ayiyi kufaneleka ukuhlawula.
- Ukuba itheyibhile ibonisa ukuba kukho umququzeleli ofanelekileyo weklinikhi kunye ne-modifier isetyenziswe, zombini iikholomu ziya kulungeleka. Umzekelo: Sebenzisa i-Modifier 59 kunye nenkqubo yesibini, eyongezelelweyo okanye encinane njengoko ibhalwe kwikholam 1 okanye ikholamu 2 ngokufanelekileyo.
I-NCCI: Imilingo engenakwenzeka
I-NCCI ingenakwenzeka ukuguqulwa kwempilo (i-MUEs) ifaka kwiikhowudi ze-CPT kunye ne-HCPCS.
Nangona ukulungiswa kwemigaqo-nkqubo-nkqubo-nkqubo kukuthintela ukuhlawulwa kweenkqubo ezingafaneleki zibikwe ndawonye kwiibango zonyango, ii-MUE zikhusela ukuhlawulwa kwenani elingalunganga leeyunithi kwinkqubo enye.
Ezinye iinkqubo zinenani eliphezulu leeyunithi ezimele zichazwe ngesigulane esifanayo seMedare (umxhamli) ngomhla omnye wenkonzo ngumniki-nye. Ngokomzekelo, ikhowudi yokuthungelwa kwendawo kufuneka ixelwe kuphela emva kwebango okanye iya kukhanyela.
Nangona kunjalo, ngelixa ugqirha kunye nezibhedlele zikhuthazwa ukuba zivakalise kuphela inani elivunyelwe likhulu leeyunithi zeekhowudi ze-CPT kunye ne-HCPCS, kufuneka zilandele izikhokelo zokuthobela.
- Gwema i inkqubo. 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.
- Gweba iinkqubo zokuhlaziya. 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.
I-NCCI: Ulungelelaniso lweKhowudi ye-Add-On
I-NCCI yokongeza i-code editshini ikhusela ukuhlawulwa kweekhowudi ezongezelelweyo ezibhekwa njengenxalenye yamacandelo e-CPT kunye neeHCPCS.
Iikhowudi ezongezelelweyo ezifakwe kwinkqubo ephambili azichazwanga ngokwahlukileyo kwaye ngoko azifanelekanga ukuhlawulwa. Nangona kunjalo, kukho iikhowudi ezongezelelweyo ezongezelelweyo kwinkqubo ephambili efanelekileyo yokuhlawula.
Incwadana ye-CPT ibonisa kwaye ineemigaqo ecacileyo kwiikhowudi ezininzi zokungena. Kwiinkqubo ezinomgaqo othile oyintloko, ikhowudi yokuongeza ayifanele ibikwe njengekhowudi yokuongeza.