Kumvetsetsa Chiwerengero cha Mawerengedwe Ovomerezeka
Cholinga chachikulu cha ndalama zomwe anthu angayang'anire ndikuyenera kukwaniritsa nthawi yochepa kwambiri yosonkhanitsira. Malipiro othandizira, omwe amadziwikanso ngati ma odwala odwala, amatanthauza ndalama zomwe zimapangidwa koma sizinasonkhanitsidwe. Kuonetsetsa kuti ndalama zikuyenda bwino ndizokwanira kuti zitheke bwino, ofesi ya zachipatala ili ndi udindo wowonjezera ndalama zomwe zingatheke.
Maofesi omwe angapezekidwe (AR) akuphatikizapo mbali zonse za ofesi ya zamankhwala.
Maofesi oyenerera omwe amalandira ndalama amafunika kumvetsetsa bwino momwe dera lililonse kapena dera lililonse limakhudzira komanso kumakhudza nthawi ya ndalama komanso nthawi ya AR. Tiyeni tione mbali zonse zisanu ndi zitatu.
1. Makhalidwe Abwino
Mfundo zalamulo zimaphatikizapo kumvetsetsa ndi kutsatira malamulo a boma ndi a boma. Madera omwe akhala akudetsa nkhaŵa kwambiri ndi chinyengo ndi nkhanza, makamaka pa Medicare, Medicaid, ndi mapulogalamu ena a federally.
Kunyenga kumatanthawuza zonena mwadala mwadala mwachipatala pofuna kuyesa pulogalamu iliyonse yothandizira ndalama. Mitundu yofala kwambiri ya chinyengo ndi nkhanza zikuphatikizapo kulipira kwa zipangizo zomwe sizinaperekedwe, kulipira kwa mautumiki omwe sanachitidwe, malipiro okhudzana ndi kukweza ndalama kuti alandire mlingo wapamwamba wobwezera, ndi kutsegula milandu.
Ofesi ya Inspector General (OIG) inapanga ndi kupereka zidziwitso zachinyengo kwa anthu odwala.
Zochenjeza izi zinali zoti zidziwitse mtundu wachinyengo kwa anthu onse. Imeneyi ndi njira yowunikira komanso kuzindikira za njira zachinyengo m'makampani ophwanya malamulo komanso madandaulo okhudza Medicare ndi Medicaid Anti-Kickback Law.
2. mgwirizano wogwirizana
Kuyankhulana kwa mgwirizano kumaphatikizapo kulimbitsa ubale wachuma ndi mabungwe osamalira.
Mabungwe osamalira omwe akuyang'anira amaimira 50 peresenti ya ndalama za maofesi ambiri azachipatala.
Kukonza mgwirizano wothandizira otsogolera kukambirana kumafuna kudziwa zambiri za mgwirizano. Izi zikuphatikizapo malipiro a kubwezera, masiku ogwira ntchito komanso otsatsa, malingaliro olembera madandaulo, malipiro a ndalama, ndi zina zomwe zikugwirizanitsa ntchito.
Njira iliyonse yothetsera mgwirizano wa ofesi ya zachipatala ndi yapadera ndipo idzakhazikitsidwa pazifukwa zosiyanasiyana, koma mfundo izi ziyenera kusungidwa m'maganizo:
- Dziwani msika: Kodi mumadziwa kuti peresenti ya msika wanu ndi Medicare, Medicaid, Cigna, Blue Cross Blue Shield, Aetna, United HealthCare kapena osatonthozedwa? Kufufuza kwa msika kumapereka chidziwitso chofunika chofunikira pa zokambirana zonse za mgwirizano.
- Dziwani izi: Kumvetsetsa malo omwe akusamalidwa bwino kuphatikizapo njira zosiyanasiyana zolipira zidzakupatsani maziko ofunikira zofunikira kuti mutenge njira yolumikizira.
- Gwiritsani ntchito mlangizi: Mabungwe ambiri amadalira kupempha thandizo kuti apereke chisamaliro chosamalidwa pokambirana chifukwa cha mgwirizano wa mgwirizano ndi malamulo omwe akukhudzidwa.
Malangizo a zamalamulo ayenela kuyankhulana pazochitika zonse za mgwirizano pamene pali zochitika zambiri komanso zosiyana siyana ku mabungwe kapena pamene zochitika za mgwirizanowo sizingakhale zogwirizana ndi utsogoleri wa utsogoleri wa ofesi ya zachipatala.
3. Kumvera
Kukhazikitsa pulogalamu yotsatilapo kumaphatikizapo kukhazikitsa bukhu lolembedwa lofotokozera ndondomeko yotsatila malamulo ndi Code Medical Conduct Code. Maofesi ambiri ogwira ntchito zachipatala amatsatira mfundo zotsatila komanso zoyenera. OIG (Office of Inspector General) amapereka zigawo zisanu ndi ziŵiri izi zomwe zimapereka maziko olimba pulogalamu yotsatila maofesi.
- Kuwunika kutsata ndi kuyesa;
- Kutsata kutsata ndikutsatira miyezo;
- Kupanga woyang'anira wogwirizana kapena kukhudzana;
- Kuphunzitsa maphunziro oyenera ndi maphunziro;
- Kuyankha moyenera ndi zolakwitsa zomwe zimawoneka ndikukonzekera kuwongolera;
- Kukulitsa mauthenga omasuka; ndi
- Kuwongolera miyezo yolangizira kudzera m'machitidwe abwino.
4. Ufulu Wopirira
Ofesi ya US Office of Personnel Management ikudziwitsa zolinga zazikulu zitatu za chitukuko ndi kugwiritsa ntchito ufulu wa Odwala.
- Choyamba, kulimbikitsa ogwira ntchito molimbika poonetsetsa kuti chithandizo chamankhwala ndi chokoma komanso chikukhudzidwa ndi zosowa za ogula, zimapereka ogwira ntchito njira zowonetsera komanso zowathandiza kuthana ndi mavuto awo, ndipo amalimbikitsa ogwira ntchito kuti athetse bwino ndi kuonetsetsa thanzi lawo.
- Chachiwiri, kutsimikiziranso kufunikira kwa ubale wolimba pakati pa odwala ndi ogwira ntchito zaumoyo.
- Chachitatu, kutsimikiziranso ntchito yovuta imene ogula amachita pofuna kuteteza thanzi lawo mwa kukhazikitsa ufulu ndi maudindo onse omwe akugwira nawo kuthetsa umoyo wawo.
Pali malo asanu ndi atatu okhudzana ndi ufulu wodwala mu ofesi ya zamankhwala.
- Chidziwitso cha odwala: odwala ali ndi ufulu wolandira zolondola komanso zosavuta kumva zokhudza dongosolo la thanzi lawo, ogwira ntchito zachipatala, komanso zipatala.
- Kusankhidwa kwa opereka: odwala ali ndi ufulu wosankha opereka chithandizo chaumoyo pamene akufunikira.
- Kufikira maulendo opatsirana : odwala ali ndi ufulu wodwala chithandizo mwamsanga ngakhale kuti sangathe kulipira.
- Chidziwitso chodziwika: odwala ayenera kuvomereza chithandizo chamankhwala ngati ali ndi zambiri zokwanira zokhudzana ndi matenda awo komanso njira zonse zothandizira zomwe angathe kuzidziwa.
- Kulemekeza ndi kusasankhana: odwala ali ndi ufulu woganizira ena, kulemekeza odwala onse komanso osasankhidwa pakapereka thandizo.
- Chinsinsi: odwala ali ndi ufulu wolankhulana payekha komanso kukhala ndi chinsinsi chachinsinsi chawo chodziwika bwino.
- Zidandaulo ndi zopempha: odwala ali ndi ufulu wothetsa chisankho chilichonse chodandaula kuchipatala.
- Maudindo oleza mtima: odwala ali ndi maudindo ambiri ku ofesi ya zachipatala kuphatikizapo kutenga nawo gawo mwakhama dongosolo lawo la mankhwala, kuthetsa pa nthawi yake kwa udindo wawo wachuma ndi kuyankhulana mwaulemu ndi antchito onse.
5. Kupeza Matenda
Kupambana kwa ofesi yanu ya zachipatala kumadalira kwambiri momwe Patient Access Services (kapena ogwira ntchito kumapeto) amachitira. Kuthamanga kwa akaunti ya wodwala kumayambira ndi kulowa koyamba kwa chidziwitso cha anthu odwala. Kumanga timagulu ta odwala matenda a dynamite ndichinthu chofunikira kwambiri kuti tithe kulimbikitsa kulipira ndi kusonkhanitsa ndalama ndikuwonjezereka bwino ntchito ya ndalama.
Zomwe zimapangitsa kuti magulu ambiri othandizira odwala ali ndi vuto lochepa kwambiri la ntchito ndi kusowa koyenera, maphunziro osaperewera, ndi kuchepa kwa ntchito. Mwamwayi, izi zikhoza kuthetsedwa mwamsanga komanso popanda ndalama zambiri.
6. Malipiro apangidwe
Kufunika kwa malipiro akuyenera kufotokozedwa ku madipatimenti onse. Ogwira ntchito zachipatala ayenera kuzindikira udindo wawo ku akaunti zomwe zimalandiridwa ndi zolemba zolondola komanso malipiro.
Kuwombera mafanowo kumaphatikizapo kulumikizana koyenera kwa zida zachipatala kwa mautumiki ndi njira zomwe zimaperekedwa pamene odwala akuchezera. Dera lililonse lachipatala limathandiza kwambiri pa nthawi yokhala ndi zolembera komanso kulondola kwa bili. Pali malo ambiri omwe amachititsa kuti awonongeko, kuphatikizapo, koma osawerengeka ku:
- Chisamaliro chosokoneza
- Kusamalira Mlandu
- Chisamaliro Chovuta
- Laboratory
- Maternity
- Medical-Surgical Unit
- Matenda a Maganizo
- Nuclear Medicine
- Uphungu Wopweteka
- Matenda
- Mankhwala
- Thandizo la Thupi
- Zamankhwala
- Kusamalidwa Kwambiri
7. Uchidziwitso cha Umoyo
Uchidziwitso cha zaumoyo ndi njira yosungira, kusunga ndi kulandira chidziwitso cha thanzi la wodwalayo mogwirizana ndi zofunikira za Federal, State, ndi mabungwe ovomerezeka. Pali maudindo khumi mkati mwa ndondomeko ya kasamalidwe ka zaumoyo.
- Coding Medical
- Kusindikiza Kwachipatala
- Zofunika Zamankhwala
- Othandiza Odwala
- Msonkhano wa Zolemba Zamankhwala
- Kusungirako Zolemba Zamankhwala
- Kujambula ndi Kubwezeretsa
- Ubwino ndi Kutetezeka
- Kutulutsidwa kwa Zambiri
- Kusunga Chinsinsi
8. Odwala Matenda Azachuma
Odwala Matenda Azachuma ndi amene amachititsa kuti ndalama zopezera ngongole komanso zosungiramo ndalama zopezeka pamsonkhano wa zachipatala zichitike.
Ndondomeko yobwezera kuchipatala imafuna kudziwa kwathunthu anthu omwe amapereka inshuwalansi ndi malamulo ndi makampani a zamalonda. Mabungwe azachipatala amachititsa kuti pulogalamu yamakono kapena akatswiri azachipatala adziwe kwa makampani a inshuwalansi monga maofesi a udokotala, zipatala, nyumba zaukhondo, kapena chipatala china.
Zotsatira zotsatila zotsatila zamagulu ku zotsatira zowonongeka za madokotala anu. Zotsatira zotsatila ziyenera kuyamba mwamsanga masiku asanu ndi awiri kapena khumi mutangotumizidwa kuti mutengedwe. Kuyesera mwamsanga kuti mulandire madandaulo sikudzangowonjezetsa masiku anu ovomerezeka koma komanso kuwonjezera ndalama.
Kugwira ntchito mokwanira ndi maphunziro abwino osonkhanitsa pamodzi kumapereka zotsatira zoyenera mu gawo lakusonkhanitsa kwa kayendedwe ka ndalama. Ogwira ntchito ku ofesi ya zachipatala ayenera kudziwa zoyenera kuchita kuti atsatire ndondomeko ya inshuwalansi.
Kugwirizana ndi mgwirizano pakati pa magawo asanu ndi atatu onse ndi mbali zofunikira za kayendetsedwe kabwino ka ndalama. Ngakhale pali zothetsa zosayembekezereka zomwe zingakhudze nthawi yothandizira AR, ndi udindo wa utsogoleri kuti uzindikire ndikukonzekera zolepheretsa kupambana kwa bungwe.