Malingana ndi CMS, madandaulo oposa 5 biliyoni azachipatala amaperekedwa kuti azilipira chaka chilichonse. Kulemba coding ndi zofunikira kuonetsetsa kuti zonena izi zikugwiritsidwa ntchito mofanana. Makampani a inshuwalansi, omwe amapereka ndalama zapadera, komanso malamulo a boma ndi boma akusonyeza kuwonjezeka kwakukulu ponena za kufunikira kokhala ndondomeko yolondola yolumikizira anthu odwala.
Pamene ogwira ntchito sakulephera kutsatira zofunikira zokhudzana ndi zolembera zomwe zili zofunika kuti pakhale njira zolipira zolipira, mwayi wokhoza kubweza ngongole.
Medicare amagwiritsa ntchito PPS (Prospective Payment System) ndi ndondomeko ya malipiro omwe amagwiritsa ntchito njira yobwezera yomwe imachokera pa ndalama zokwanira. Pali PPSs pamodzi ndi ndondomeko ya malipiro pogwiritsa ntchito mautumiki operekedwa.
Zolinga Zopereka Zikalata
- Zipatala zosayembekezereka
- Mabungwe a zaumoyo kunyumba
- Hospice
- Chipatala chachipatala
- Malo odwala matenda opatsirana opaleshoni
- Malo osungirako anthu odwala matenda opatsirana
- Zipatala za nthawi yaitali
- Unamwino wodziwa bwino ntchito
Ndondomeko za Malipiro
- Madokotala
- Mapulogalamu ambululu
- Ntchito zachipatala zachipatala
- Zipangizo zamankhwala zosatha, ma prosthetics, orthotics, ndi zina
Pansi pa PPS ndi Pulogalamu ya Malipiro, wopereka aliyense amalipiritsa ndalama zokonzedweratu malinga ndi ndondomeko ya ndondomeko yofotokozera. Kulemba kolakwika kosayenera kungawononge kulephera kutsatira malamulo oyenera.
Pali malo khumi omwe akugwirizana ndi njira zolakwika zochiritsira matenda.
- Kuwonetsa mayendedwe olakwika a utumiki
- Ngongole yosayenera yoyang'anira maonekedwe
- Kulipira milandu yolakwika chifukwa cha kufotokoza kwa nthawi yamagazi
- Kupereka zolemba zochepa kapena kulephera kutsata malangizo a NCCI (National Correct Coding Initiative) kwa Medicare ndi Medicaid
- Malipoti osayenera a ndondomeko ya code modifiers
- E / M (Kufufuza ndi Kulamulira) zosasankhidwa
- Kufotokozera njira yothetsera "odwala" pokhapokha ngati akunena zakukhosi
- Kugonjera zodzinsoza zazinthu zosafunika za mankhwala
- Kulephera kutsatira malamulo angapo owonetsera malamulo
- Mapulogalamu operekedwa ndi wogwira ntchito, wokhalapo kapena wothandizira wina yemwe ali ndi udindo wosavomerezedwa popanda woyang'anira dokotala
Zolakwitsa zokopera zingathe kukhala ndi zinthu zingapo.
- Zovuta za nthawi ndi / kapena zoletsa
- Zosokoneza
- Kusasowa kwa chiwerengero chokopera
- Zolakwika za anthu
- Kusayankhulana
- Zotsatira za odwala zosakhalitsa
Zinthu izi zimakhala zosachita mwadala koma pamene zokopera zolakwika zikuchitika pokhazikika, opereka angaganizidwe kuti akutsutsana ndi Zowonongeka Zowonongeka kwazochitika zowononga ndalama. Nthaŵi zina chinyengo chimasokonezeka ndi kuzunzidwa. Nkhanza ndi kulipira mwangozi kwa zinthu kapena ntchito zomwe sizinaperekedwe. Madera anayi omwe amadziwikanso ngati Chinyengo kapena Nkhanza ndi awa:
- Kulipirira Zida Zamankhwala Sizinaperekedwepo
Malo ofala kwambiri a chinyengo cha Medicare ndi kulipira kwa Zipangizo Zamankhwala Zosatha (DME). DME imatanthawuza zipangizo zamankhwala zilizonse zofunikira kuchipatala kapena matenda. Zimaphatikizapo mipando ya olumala, mabedi a chipatala, ndi zipangizo zina za chikhalidwechi. Wopereka ndalamayo adzapereka Medicare kwa zipangizo zomwe wodwalayo sanalandirepo. Ophunzira othamanga akhala akudziwika kwambiri ndi mapulani achinyengo a Medicare.
- Kulipira kwa Mapemphero Simunayambe Kuchitidwa
Pachifukwa ichi, ngongole zomwe amapereka zothandizira, chithandizo kapena ndondomeko zisanachitike. Izi zikhoza kuwonjezeredwa pa mndandanda wa mayesero omwe wodwalayo walandira ndipo sazindikiridwa konse. Wothandizira angagwiritsenso ntchito zizindikiro zogonana kuti awonjezere mayesero kapena ntchito zina zosafunikira.
- Malipiro Otsutsa
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.
- Malipiro osokoneza
Mautumiki ena amalingaliridwa onse. Kutseketsa ndiko kulipira kwa njira zosiyana zomwe nthawi zambiri zimawerengedwa ngati ndalama imodzi. Mwachitsanzo, ngongole zomwe amapereka zothandizira mafilimu awiri osagwirizanitsa, mmalo molipilira ndalama zowunikira limodzi.
Malingaliro olembera makalata amalola wogulitsa inshuwalansi kudziwa zizindikiro, matenda kapena kuvulala kwa wodwala komanso njira yomwe adokotala amachitira. Kulemba zolakwika kumapezeka pamene pempho likuperekedwa kwa kampani ya inshuwalansi ndi vuto lodziŵa matenda kapena ndondomeko yovomerezeka pazomwe akunena. Kulemba zolakwika zolakwika kumabweretsa mavuto ambiri. Ndikofunika kuti ofesi ya zachipatala ikhale ndi dongosolo lotsatira malamulo lomwe lingalepheretse kuphwanya malamulo okhudzana ndi mankhwala.