Zolondola zimadalira pazigawo zambiri. Kukhazikitsa nthawi yatsopano kusintha kwa coding, kutsata ndondomeko yoyenera yolembera ndi kusunga ndondomeko yokhudzana ndi odwala ndi njira zosavuta kuti zitsimikizo zachipatala zikhale zolondola.
Kulemba kwa madandaulo a Medicare ali ndi zofunikira zomwe anthu omwe angapereke angathenso kutanthawuza kupeŵa kukana zolembera kapena zosayenera.
Chotsatira ichi cha zolembera zolembera chimatchedwa NCCI kapena CCI ndondomeko ya mautumiki a Medicare.
Cholinga cha National Coding Initiative (NCCI) chinakhazikitsidwa ndi Centers of Medicare ndi Medicaid Services (CMS) popewera Medicare osayenera chifukwa cha zolakwika zokopera.
Pali mitundu itatu ya kusintha kwa NCCI:
- Ndondomeko yotsata njira
- Zosintha zosakayika
- Zowonjezerani zizindikiro zosinthidwa
Malingana ndi CMS, ndondomeko ya coding ya NCCI imasankhidwa ndipo ikugwirizana ndi kuphatikiza malamulo osiyanasiyana okhudzana ndi zolembera kuphatikizapo:
- Buku la Current Procedural Terminology (CPT) la American Medical Association's (AMA)
- Malingaliro a Medicare a m'midzi ndi a dziko
- Ndondomeko za mayiko onse
- Zotsatira zachipatala
- Zotsatira zamakono zamakono
Webusaiti ya CMS imapereka zida zambiri kwa opereka kuti azilemba molondola ndondomeko zachipatala.
- Buku Loyenera la Zopangira Mfundo Zokonza Maphunziro a Medicare Services
- Zosintha za NCCI zomwe zimagwiritsidwa ntchito pazinthu zachipatala
- Zosintha za NCCI zomwe zimagwiritsidwa ntchito ponena za chipatala cha kunja kwapakati pa Outpatient Code Editor (OCE)
- Mafunso Ofunsidwa Kawirikawiri (FAQ)
- Phunziro mwachidule
- Mafunso Omwe Amafunsa Kawirikawiri (FAQ)
- Ndondomeko za HCPCS / CPT ndi zilembo za MUE zofalitsidwa mu tebulo la Practitioner / DME Supplier MUE
- Ndondomeko za HCPCS / CPT ndi zolemba za MUE mu chipatala cha Hospital Outpatient Services MUE
- Ndondomeko za HCPCS / CPT ndi zilembo za MUE zosungidwa mu Durable Medical Equipment
- Zolemba zamakono zamakono zamakono zimasintha kwa NCCI kusintha ndi kusindikiza MAU
- Medicare Learning Network Kufalitsidwa: "Medicare Claim Review Review Programs: MR, NCCI Kusintha, Mapulogalamu, ndi Kukonzanso Audit Program"
- Medicare Learning Network Othandizira: "Mmene Mungagwiritsire Ntchito Zida Zachilengedwe Zokongola Zachilengedwe (NCCI)"
NCCI: Kusintha kwa ndondomeko ndi njira
Ndondomeko ya NCCI yowonjezera njira zonse za CPT ndi HCPCS.
Zizindikiro za CPT ndi Machitidwe Odziwika Amodzi ndipo zinapangidwa ndizolembedwa ndi American Medical Association mu 1966. Awa ndiwo dongosolo la zilembo zisanu za alphanumeric zomwe zimalongosola mu njira yovomerezeka yachipatala, opaleshoni, ndi matenda.
HCPCS kapena Healthcare Common Procedure Coding System Maofesi I ndi II. Mndandanda ndili ndi zizindikiro za CPT, ndipo Mzere Wachiŵiri umaphatikizapo zizindikiro zogwiritsira ntchito zomwe zimagwiritsidwa ntchito pozindikira zinthu, katundu, ndi ntchito zomwe sizikuphatikizidwa ndi zida za CPT zikagwiritsidwa ntchito kunja kwa ofesi ya udokotala.
Ndondomeko ya NCCI yokonza njira zowonongetsera kulandira malipiro ndi malipiro a misonkhano zomwe siziyenera kuwerengedwa pazinthu zonse pamodzi. Kusintha kwa NCCI kungapezeke pa matebulo anayi omwe akupezeka pa webusaiti ya CMS.
Magomewawa ndi ofotokoza za zipatala ndi madokotala kuti azindikire zigawo zomwe sizikhoza kuperekedwa pazinthu zomwezo kapena zimagwirizana. Ngati malingaliro ali ndi zizindikiro zonse, pali zinthu ziwiri zomwe zingatheke:
- Malingana ndi momwe kachidindo ilili m'ndandanda 1 kapena ndime 2 ya tebulo, ndondomeko yachiwiri yachiwiri idzakana. Chitsanzo: Wopereka chithandizo sayenera kulongosola zochitika zapadera zomwe zimagwiritsidwa ntchito poyeza matenda. Sitiyenera kulandira malipiro omwe sagwirizana nawo.
- Ngati gome likuwonetsa kuti pali kusintha kosinthika kwa kachipatala ndipo kusinthako kukugwiritsidwa ntchito, zipilala zonsezi ziyenera kulandira. Chitsanzo: Gwiritsani ntchito Modifier 59 ndi ndondomeko yachiwiri, yowonjezera kapena yowonjezera yomwe ili mu ndondomeko yoyamba kapena ndime 2 ngati zili zoyenera.
NCCI: Kusintha Kwambiri Mwamaganizo
NCCI zosinthika zosayembekezereka mankhwala (MUEs) zimagwiranso ntchito pa code CPT ndi HCPCS.
Ngakhale kusintha kwa kayendetsedwe kachitidwe kachitidwe kafukufuku kumalepheretsa kulipira kwa njira zomwe siziyenera kuyanjanitsidwa palimodzi pa chithandizo cha zamankhwala, MUE amaletsa kulipira kwa chiwerengero chosayenera cha mayunitsi pa njira imodzi.
Njira zina zimakhala ndi chiwerengero chachikulu cha mayunitsi omwe ayenera kufotokozedwa ndi wodwalayo Medicare wodwala (wopindula) pa tsiku lomwelo la utumiki ndi wothandizira omwewo. Mwachitsanzo, chikhomo chokhacho chiyenera kubwerezedwa kamodzi pazinthu zodziwika kapena zikana.
Komabe, ngakhale madokotala ndi zipatala akulimbikitsidwa kulengeza chiwerengero chololedwa cha mayunitsi a ma CPT ndi a HCPCS, amatsatiranso kutsata malangizo.
- Pewani kusokoneza njira. Mautumiki ena amalingaliridwa onse. Kutseketsa ndiko kulipira kwa njira zosiyana zomwe nthawi zambiri zimawerengedwa ngati ndalama imodzi. Mwachitsanzo, ngongole zomwe amapereka kwa maulendo awiri osamalirana, m'malo molipira ndalama zowunikira limodzi.
- Pewani njira zothandizira. Kuwonetsa molakwika ntchito yamtundu kapena ndondomeko yochitidwa pofuna kulipiritsa zambiri kapena kulandira mlingo wapamwamba wa kubwezera kumatengedwa ngati kukweza. Kukonzekanso kumachitika pamene ntchito yodaliridwa siyikugwiritsidwa ndi Medicare koma ndalama zomwe amapereka zimagwirira ntchito pamalo ake.
NCCI: Kusintha kwa Malemba Owonjezera
Kusintha kwa code NCCI kumalepheretsa kulipira kwa zizindikiro zowonjezera zomwe zimaonedwa ngati mbali ya zigawo zoyamba za CPT ndi HCPCS.
Zizindikiro zowonjezera zomwe zimaphatikizidwa mu njira yoyamba sizinayankhidwe payekha ndipo kotero siziyenera kulandira malipiro. Komabe, pali zizindikiro zina zowonjezera zomwe zimaphatikizapo njira yoyamba yomwe ikuyenera kulipira.
Buku la CPT limadziwika ndipo liri ndi malangizo enieni a ma code ambiri owonjezera. Kwa njira zomwe zili ndi code yapaderayi, makalata owonjezera sayenera kuwonedwa ngati chikhomo chowonjezera.