Medicare Secondary Payer (MSP) ndi gawo lofunika kwambiri lopereka zifukwa zomwe ziyenera kumvetsetsedwa ndi ndalama zamalonda. Malamulo angakhale ovuta. Maofesi azachipatala omwe Bill Bill akuyenera kuonetsetsa kuti ogwira ntchito awo omwe ali ndi udindo wokonzekera ndikupereka zomwe akufunsayo akuphunzitsidwa bwino ndikukhalabe ndizinthu zogwirizana ndi malamulo. Taganizirani kupita ku zochitika ndi maphunziro.
Kodi MSP ndi chiyani?
Medicare Secondary Payer kapena MSP imatchula madalitso a Medicare pamene Medicare si inshuwalansi yayikulu. Medicare imafuna kuti onse ogwira ntchito zaumoyo adziwe momwe Medicare aliri inshuwalansi yapamwamba kapena yachiwiri kwa odwala awo a Medicare.
Dziwani ndi CWF
CWF kapena Common Working File ndi ntchito ya Medicare yomwe imapereka chidziwitso chokhudzana ndi operekera thandizo kwa Medicare . Onetsetsani kuti nthawi zonse muyang'ane CWF kuti muwone momwe MSP ikudziwira kuti mupeze inshuwalansi yathanzi.
Odwala omwe Amalipiritsa Phindu Loyamba
Medicare ndiwopereka ndalama zambiri kwa wodwala amene amakwaniritsa izi:
- 65 kapena kupitilira ndipo ali ndi kagulu kakang'ono ka thanzi labwino kupyolera mwa awo enieni omwe akugwira nawo ntchito kapena mwa abwenzi awo omwe alipo tsopano
- 65 kapena kupitilira ndi inshuwaransi kupyolera mu ndondomeko yopuma pantchito
- Olemala ndipo ali ndi ndondomeko ya thanzi la gulu laling'ono kupyolera mwa abwana awo pakalipano kapena kupyolera mwa abwana awo pakali pano
Odwala Amene Amalipiritsa Patsiku la Medicare
Medicare ndi malipiro achiwiri kwa wodwala amene amakwaniritsa izi:
- 65 kapena kuposa ndipo ali ndi ndondomeko yachipatala cha gulu lalikulu kupyolera mwa omwe akugwira ntchito panopa kapena kudzera mwa abwana awo omwe alipo tsopano
- Olemala ndipo ali ndi ndondomeko yathanzi lachidziwitso cha gulu lonse kudzera mwa abwana awo pakalipano kapena mwa abwenzi awo omwe alipo tsopano
- Ikuphimbidwa ndi Mphoto ya Ogwira Ntchito
- Amaphimbidwa ndi inshuwalansi yowopsa kapena yobweza
Kodi Medicare Imatani Ngati Maphunziro A Inshuwalansi Akukana Kufunsidwa?
Muzochitika kuti inshuwalansi yoyamba imakana, Medicare ikhoza kulipira zifukwa zina zokana, monga:
- Ndondomeko ya olembetsa yatha
- Malipiro a antchito atsimikiza kuti misonkhano siidakumbidwe
- Inshuwalansi yachinyengo kapena yachinyengo imakana kapena imatenga nthawi yaitali kuti ilipire. Woperekayo angakhale woyenera kupeza malipiro ngati zifukwa zake zikuyembekezeredwa kutenga nthawi yochulukirapo.
Kugwiritsa Ntchito Mndandanda Mndandanda wa FL 18-28
Code 02: Mkhalidwe ndi wogwirizana ndi ntchito
Mutu 03: Wodwala Wophimbidwa ndi inshuwalansi wosatchulidwa pano
Chikhumbo 05: Chiwonetsero chayitanidwa
Mutu 06: Wodwala wa ESRD mu miyezi 30 yoyamba yoyenera
Code 08: Wopindula sangapereke zambiri zokhudza inshuwalansi
Mutu 09: Wopirira kapena mkazi sagwiritsidwa ntchito
Mutu 10: Wodwala ndi / kapena mwamuna wake akugwiritsidwa ntchito koma osati ku EGHP kulipo
Mutu 11: Othandizira olumala koma palibe mauthenga a LGHP
Mutu 28: EGHP odwala komanso / kapena wokwatirana ndi wachiwiri
Mutu 29: Wopindula ndi odwala omwe ali ndi HIV / kapena LGHP waumwini ndi wachiwiri kwa Medicare
Mutu 77: Wopereka amavomereza kapena akuyenera / akufunikira chifukwa cha mgwirizano kapena lamulo lovomerezeka kuti avomereze malipiro ndi wolipidwayo monga malipiro athunthu. Palibe malipiro a Medicare omwe angapangidwe.
Kugwiritsira ntchito Occurrence Ma fomu FL 31-34
Code 01: Kuwunikira kulipira kwa chithandizo chachipatala
Code 02: Palibe inshuwalansi yolakwika yomwe imagwiritsidwa ntchito (gwiritsani ntchito phindu lenambala 14)
Mutu 03: Ngozi - udindo (kugwiritsira ntchito ndondomeko ya mtengo 47)
Mutu 04: Ngozi - ntchito yokhudzana ndi ntchito (gwiritsani ntchito phindu lenambala 15)
Mutu 06: Wopanda chiwawa
Mutu 18: Tsiku lopuma pantchito / wothandizira
Mutu 19: Tsiku lopuma pantchito
Code 24: Tsiku la inshuwalansi yakutsutsa
Mutu 33: Tsiku loyamba la mgwirizano kwa opindula a ESRD opangidwa ndi EGHP
Code A3: Malipiro Mapindu atopa
Kugwiritsira ntchito Mapulogalamu ofunika FL 39-41
Lowani ndalama ya kulipira kwa Payer A yomwe ili pa FL 50 pa Ma Code 12 - 43:
Mutu 12: Kugwira ntchito wokalamba wothandizira kapena wokwatirana naye
Mutu 13: Wothandizidwa ndi ESRD mu mgwirizano wa miyezi 30
Mutu 14: Inshuwalansi yopanda chilema kuphatikizapo galimoto
Code 15: Malipiro a antchito
Mutu 16: Utumiki waumoyo wa anthu kapena bungwe lina la federal monga wozunzidwa, yesero la mankhwala, etc.
Code 41: Mphungu yakuda
Mutu 42: Ulamuliro wa Wachiwiri
Code 43: Wopindula odwala omwe ali ndi zaka 65 ndi LGHP
Mutu 44: Wopereka ndalama amavomereza kuvomereza kuchokera ku malipiro oyambirira pamene ndalamayi ili yochepa kusiyana ndi malipiro koma apamwamba kusiyana ndi malipiro omwe amalandira, ndiye wothandizira wachiwiri wa Medicare akuyenera. Lowani chiwerengero chonse chimene munavomereza kapena mukuyenera kuvomereza.
Mutu 47: Inshuwalansi yachinyengo
Kugwiritsira Maubale Amtundu FL 59
Code 01: Wokwatirana
Mutu 04: Agogo aakazi / agogo aakazi
Code 05: Agogo / mdzukulu
Code 07: Mwana wamwamuna / mwana wamwamuna
Mutu 10: Mwana wothandizira
Code 15: Ward
Mutu 17: Stepson / mwana wobadwa naye
Mutu 18: Kudzikonda
Code 19: Mwana
Mutu 20: Wogwira ntchito
Mutu 21: Wosadziwika
Mutu 22: Wodalira wodwala
Code 23: Kudalira wothandizidwa
Mutu 24: Wodalira anthu odalira pang'ono
Mutu 29: Zina zofunika kwambiri
Mutu 32: Mayi
Mutu 33: Atate
Mutu 36: Wophunzira pang'ono
Mutu 39: Wopereka bungwe
Mutu 40: Wopereka ndalama
Mutu 41: Wotsutsa wovulala
Mutu 43: Mwana yemwe ali ndi inshuwalansi alibe udindo wachuma
Mutu 53: Wothandizana naye
Code G8: Ubwenzi wina
Pitani ku Medicare Claims Processing pa webusaiti ya cms.gov kuti mupeze mndandanda wathunthu wa zikhopi zonse.