Malipiro Otsutsa Amayi Opaleshoni Opaleshoni
Malo Othandizira Opaleshoni (ASC) amatanthauzidwa ndi CMS ngati malo omwe ali ndi cholinga chokhalira kupereka opaleshoni yopita kuchipatala kwa odwala. Malo ogwiritsira ntchito opaleshoni amatha kudziwika ndi chipatala chokhala ndi chipatala kapena angakhale malo ogwiritsira ntchito opaleshoni opita kuchipatala.
Ngakhale kuti ASC imanena zofanana ndi zomwe zimachitika kuchipatala pankhani ya kulipira, pali kusiyana kwakukulu kwambiri.
Ma AS Claim Claims - Amene mungagwiritse ntchito
Mabungwe opatsirana opaleshoni opatsirana amavutitsidwa ku Medicare, Medicare Advantage Plans, ndi Medicaid pa HCFA 1500 kapena 837P. Izi ndi zosiyana ndi opaleshoni yachipatala yopereka chithandizo kwa odwala, omwe amawatumiza ku UB-04 kapena 837I.
CMS-1500 ndi inki yofiira pamapepala oyera omwe amafunidwa ndi madokotala ndi ogulitsa katundu chifukwa cholipira ngongole. Aliyense wosapereka chithandizo ndi wogulitsa angagwiritse ntchito CMS-1500 kuti adziwe zachipatala. Baibulo lamakono la CMS-1500 limatchedwa 837-P, P yomwe imayimilira akatswiri.
The UB-04 kapena 837-Ine ndimagwiritsidwa ntchito ndi ASCs kupereka madokotala kuchipatala kwa ena onse olipidwa.
Bill ya ASC
Mukamapereka mavoti pa UB-04, mtundu wa ndalama za ASC ndi 83X.Chiwerengero choyamba chikutanthauza mtundu wa malo: 8 - Zapadera, Chipatala chachipatala cha ASC Chiwerengero chachiwiri chimatanthawuza misonkho: 3 - Odwala
Nambala yachitatu imatanthawuza nthawi yomwe imayimilira pamwamba ndi X.
1 - Landirani kudzera pa Discharge Claim
7 - Kubwezeredwa kwa Chidziwitso Choyambirira kapena Chidziwitso Chokonzedwa
8 - Kuwoneka kapena Kuletsedwa kwa Chidziwitso Choyambirira
Misonkho ya Mapepala
Mukamapereka zifukwa pa UB-04, chikhombo cha ndalama chomwe chimagwiritsidwa ntchito kuti chidziwitse njira zoyendetsera opaleshoni ndizo 490.
Kugwiritsa Ntchito Kusintha
Zomveka za ASC zingakhale zosokoneza chifukwa olemba malire amangofuna mitundu yosiyanasiyana ya mawonekedwe, amafunikanso kugwiritsa ntchito zolemba zosiyanasiyana.
Medicare Modifiers
Medicare imafuna kusintha kosinthazi polemba ndondomeko zina zomwe ASC imanena:
Kusintha RT - Kumanzere (kumagwiritsidwa ntchito pofuna kuzindikira njira zomwe zimachitika kumanja kwa thupi)
Kusintha LT - Kumanzere (kumagwiritsira ntchito njira zomwe zimagwira kumanzere kwa thupi)
Sinthani TC- Zida zamakono
Kusintha 52 - Zothandizira kuchepa
Kusintha 59 - Njira yosiyana yosiyana
Kusintha 73 - Ndondomeko yotsalira pambuyo pa kukonzekera kwa opaleshoni
Kusintha 74 - Ndondomeko yotsalira pambuyo poti anesthesia imayendetsedwa
Kusintha FB - Chipangizo choperekedwa popanda ndalama / ngongole yonse
Modifier FC - Chipangizo chinaperekedwa ku ngongole yachepa
Sinthani PA - Chigawo cholakwika cha thupi
Kusintha PB - Opaleshoni odwala opaleshoni
Kusintha PC - Opaleshoni yolakwika pa wodwalayo
Kusintha PT - Kuwonetsera kosalala komwe kunatembenuzidwa ku njira yothandizira kapena kuchiza / opaleshoni
Kusintha GW - Kuchita opaleshoni sikunagwirizane ndi matenda odwala matenda odwala
Medicaid Modifier
Ngakhale Medicare ikugwiritsira ntchito kusintha kumeneku, Medicaid safuna kugwiritsa ntchito iliyonse ya izi. Chokhacho chosinthika chotsimikizirika cha Medicaid ndi modifier SG chomwe chimasiyanitsa chigamulo monga choyendetsa chithandizo chopangira opaleshoni.
Ndikofunika kufotokoza SG kusintha kwa code iliyonse ya CPT mosasamala kulipira kuti athe kusiyanitsa kulipira kuchokera ku chidziwitso cha akatswiri pa ntchito yomweyo.
Other Insurer Modificers
Chitsanzo china cha kusiyana kwa ntchito ya modifiers ndi kuti Blue Cross Blue Shield ** imafuna kugwiritsa ntchito kusintha kodasintha 50, komwe kumasiyanitsa ndondomekoyi monga magawo awiri ogwira ntchito. Medicare, kumbali inayo, imafuna kusintha 50 kapena kusintha RT ndi LT pamzere wosiyana ndi 1 unit of service.
** Malangizo okhomera ngongole amasiyana ndi boma. Fufuzani ndi buku la boma la BCBS kuti mudziwe.