Medicare ndi makampani ambiri a inshuwalansi a zaumoyo amapereka zipatala pogwiritsira ntchito DRGs, kapena kugwirizana kwa magulu . Izi zikutanthauza kuti chipatala chimalipiridwa malinga ndi momwe wodwalayo akudziwira m'malo mogwiritsira ntchito zomwe zimagwiritsidwa ntchito posamalira wodwala kuchipatala.
Ngati chipatala chingachiritse wodwalayo ndikugwiritsa ntchito ndalama zochepa kuposa kubwezera kwa DRG kwa matendawa, chipatala chimapanga phindu.
Ngati, pochiza wodwala kuchipatala, chipatala chimakhala ndi ndalama zambiri kuposa kubwezera kwa DRG, chipatala chidzataya ndalama pa chipatala cha wodwalayo. Izi zimatanthawuza kuwonetsa ndalama zothandizira zaumoyo powalimbikitsa chisamaliro choyenera cha odwala kuchipatala.
Chifukwa Chake Muyenera Kusamala Momwe DRG Imatsimikizidwira
Ngati ndinu wodwala, kumvetsetsa zofunikira zomwe zimakhudzidwa ndi ntchito yanu ya DRG zingakuthandizeni kumvetsa bwino chipatala cha chipatala, zomwe kampani yanu ya inshuwalansi ya mankhwala kapena Medicare ikulipira, kapena chifukwa chake mudapatsidwa DRG.
Ngati muli dokotala osati wodwala, kumvetsetsa momwe mungaperekere DRG kungakuthandizeni kumvetsetsa momwe zolembera zanu mukodi ya mankhwala zikukhudzira DRG ndi zomwe Medicare idzabwezera kuchipatala cha wodwalayo. Idzakuthandizani kumvetsetsani chifukwa chake zikhomo ndi antchito omvera amakufunsani mafunso omwe akufunsa.
Zomwe Zidzasintha Dongosolo la DRG
Izi ndizomwe zimakhala zosavuta kuzigwiritsa ntchito poyendetsa chipatala chomwe chipatala chikugwiritsira ntchito kuti adziwe DRG ya wodwala kuchipatala. Izi sizomwe ndondomekoyi imachitira; mu dziko lenileni, zolembera zimathandizidwa kwambiri ndi mapulogalamu.
- Dziwani chithandizo chachikulu cha kuvomereza kwa wodwalayo.
- Onetsetsani ngati mukuchita opaleshoni kapena ayi.
- Onetsetsani ngati pali zochitika zazikulu za comorbid kapena mavuto. Khalidwe la comorbid ndi vuto lina lachipatala lomwe likuchitika panthawi imodzimodzi monga vuto lalikulu lachipatala. Kungakhale vuto lofanana, kapena losagwirizana kwenikweni.
Chitsanzo
Tiyeni tiwone kuti Akazi a Macheza omwe akukalamba akubwera kuchipatala ndi khosi lachikazi lophwanyika, lomwe limadziwika kuti ndiphuka . Amafuna opaleshoni ndikupatsanso chikho chonse . Pamene akuchira pa opaleshoni yake yam'chipinda, vuto lake la mtima limatha ndipo amayamba kupwetekedwa mtima kwa systolic congestive mtima . Potsirizira pake, madokotala ake amachititsa amayi a Gomez kugonjetsedwa mtima, akuchiritsa bwino, ndipo amamasulidwa ku malo osungirako anthu odwala matenda opatsirana kuti asamapite kunyumba.
Mavuto a amayi a Gomez adatuluka pakhosi la mkazi. Njira yake yopaleshoni imakhudzana ndi matenda ake akuluakulu ndipo amatha kubwezeretsa. Kuonjezera apo, ali ndi vuto lalikulu lachisokonezo cha mtima: kuchepa kwa mtima kosasinthasintha mtima.
Pamene mauthenga osokoneza mauthenga onsewa athandizidwa mu mapulogalamu, pulogalamuyi idzalankhula ndi DRG ya 469, yomwe ili ndi mutu wakuti "Zowonjezereka Zowonjezera Kapena Zowonjezera Zomwe Zili Zochepa Kwambiri ndi MCC."
Zambiri Za Gawo 1: Kufufuza Kwambiri
Gawo lofunika kwambiri pakugawira DRG ndiko kupeza chidziwitso chachikulu choyenera. Izi zimawoneka zophweka koma zingakhale zovuta, makamaka pamene wodwalayo ali ndi mavuto osiyanasiyana azachipatala akuchitika nthawi yomweyo. Malingana ndi CMS , "Chidziwitso chachikulu ndicho chikhalidwe chomwe chinakhazikitsidwa pambuyo powerenga kuti ndicho chachikulu chovomerezeka."
Chidziwitso chachikulu chiyenera kukhala vuto lomwe munalipo pamene munaloledwa kuchipatala; izo sizingakhoze kukhala chinachake chimene chinapangitsidwa mutatha kulowa. Izi zikhoza kukhala zovuta chifukwa nthawizina dokotala wanu sakudziwa zomwe zili zolakwika ndi inu pamene muloledwa kuchipatala.
Mwachitsanzo, mwinamwake mumaloledwa kupita kuchipatala ndikumva ululu m'mimba, koma dokotala samadziwa chomwe chimapweteka. Zimatengera iye nthawi pang'ono kuti adziwe kuti muli ndi khansa yamtundu komanso khansara yamtunduwu imayambitsa ululu wanu. Popeza khansara yam'koloni inalipo pamalo ovomerezeka, ngakhale kuti dokotala sakudziwa zomwe zimayambitsa ululu mukavomerezedwa, khansara yamtundu ingaperekedwe ngati matenda anu aakulu.
Zambiri Za Gawo 2: Njira Yopangira Opaleshoni
Ngakhale kuti izi zikuwoneka zochepetsedwa komanso zowuma, monga zinthu zambiri zokhudza inshuwalansi ndi Medicare, siziri choncho. Pali malamulo angapo omwe amatsimikizira ngati njira ya opaleshoni imakhudzira DRG.
Choyamba, Medicare imatanthauzira zomwe zimawerengedwa ngati njira yopaleshoni pofuna kukonza DRG, ndipo zomwe sizikuwoneka ngati opaleshoni. Zinthu zina zomwe zimawoneka ngati opaleshoni kwa wodwalayo zomwe sizikuchitika sizinagwiritsidwe ntchito ngati opaleshoni pogawira DRG yanu.
Chachiwiri, ndikofunikira kudziŵa ngati njira yopaleshoni yomwe ili mufunsoyi ili m'gulu lalikulu lomwe limagwiritsidwa ntchito ngati matendawa. Chidziŵitso chilichonse chachikulu ndi gawo lalikulu la matenda opatsirana, malinga ndi kayendedwe ka thupi. Ngati Medicare akuwona kuti njira yanu yothandizira ikhale m'gulu lalikulu lomwe mumapeza ngati matenda anu aakulu, DRG yanu idzakhala yosiyana kusiyana ndi ngati Medicare ikuwona kuti njira yanu yopaleshoni isagwirizane ndi matenda anu aakulu. Mu chitsanzo chapamwambachi ndi Akazi a Gomez, Medicare akuwona kuti opaleshoni yotsalira m'malo mwake ndi mchiuno wophulika kuti akhale m'gulu lalikulu lomwe limagwiritsidwa ntchito.
Zambiri Zokhudza Gawo 3: Zochitika ndi Zovuta za Comorbid
Popeza amagwiritsira ntchito zowonjezera zambiri ndipo zimakhala zofunikira kwambiri kuti asamalire wodwala monga amayi a Gomez omwe ali ndi chipsinjo chophwanyika komanso chosowa mtima chosowa mtima kusiyana ndi kusamalira wodwala wamphwa wosweka ndi mavuto ena, ambiri a DRG amatenga izi kuganizira. Medicare imasiyanitsa ngakhale pakati pa zikuluzikulu zomwe zimakhala ngati comorbid zomwe zimachititsa kuti mtima usasokonezeke kapena sepsis, komanso kuti sizinthu zoopsa kwambiri zomwe zimachitika ngati COPD. . Milandu ngati iyi, pangakhale magulu atatu a DRG, otchedwa DRG triplet:
- DRG yomwe imalipiritsa malipiro ochepa kuti apeze matenda osokoneza bongo popanda mavuto kapena comorbid.
- DRG yomwe imalipiritsa maseŵera ambiri kuti adziwe ngati ali ndi matenda aakulu. Izi zimadziwika kuti DRG ndi CC kapena c omorbid c kudodometsa.
- DRG yowonjezera kwambiri chifukwa chodziwika kwambiri ndi matenda a comorbid, odziwika ngati DRG ndi MCC kapena m ajor c omorbid c kuvota.
Ngati ndinu dokotala wofunsa mafunso kuchokera ku dipatimenti yolembera kapena kuwonetsetsa, ambiri mwa mafunsowa adzalingalira ngati wodwalayo akuchiritsidwa ndi CC kapena MCC pamene chipatala chake sichikuchitikanso ndi mankhwala matenda.
Ngati mukuyang'ana wodwalayo pa kalata yanu kapena ndondomeko ya phindu lanu komanso kampani yanu inshuwalansi imabwereka kuchipatala pogwiritsa ntchito njira ya kulipira kwa DRG, mudzawona izi zikuwonetsedwa mu mutu wa DRG womwe munapatsidwa. Dzina la DRG lomwe limaphatikizapo "MCC" kapena "ndi CC" limatanthauza kuti, kuphatikizapo kuchiza chidziwitso chachikulu chomwe munalandira, chipatalacho chinagwiritsanso ntchito zothandizira kuchipatala panthawi ya chipatala.