Zolakwa Kukopera Zikhoza Kuwononga Ndalama
Inshuwalansi amagwiritsidwa ntchito ndi ndondomeko yanu yaumoyo kupanga zosankha za momwe mungapereke dokotala wanu ndi ena othandizira zaumoyo. Kawirikawiri, inu mudzawona zizindikiro izi pa Kufotokozera kwa Madalitso ndi ngongole zamankhwala.
Tsatanetsatane wa Mapindu (EOB) ndi mawonekedwe kapena zolemba zomwe mungatumizidwe kwa kampani yanu ya inshuwalansi milungu ingapo kapena miyezi ingapo mutalandira chithandizo chaumoyo chomwe chinalipiridwa ndi kampani ya inshuwaransi.
EOB yanu ndiwindo mu mbiri yanu yowolapira zachipatala. Onetsetsani mosamala kuti muthe kulandira msonkhanowo, ndalama zomwe dokotala wanu analandira komanso gawo lanu ndi lolondola, komanso kuti zomwe mwapeza ndi ndondomeko zanu zili zolembedwera ndizolembedwa.
Kufunika kwa Inshuwalansi Mapu
Maofesi, mawonekedwe a inshuwalansi, ndi ngongole zamankhwala kuchokera kwa dokotala kapena kuchipatala zingakhale zovuta kumvetsa chifukwa cha kugwiritsa ntchito zizindikiro kufotokozera mautumiki opangidwa ndi momwe mumadziwira. Zizindikirozi nthawi zambiri zimagwiritsidwa ntchito m'malo momveka bwino Chingerezi ndipo zingakhale zothandiza kuti muphunzire za zizindikirozi, makamaka ngati muli ndi vuto limodzi kapena matenda ambiri.
Mwachitsanzo, mamiliyoni ambiri a ku America ali ndi matenda a shuga a mtundu wa 2 komanso kuthamanga kwa magazi komanso cholesterol. Gulu la anthuli likhoza kukhala ndi mautumiki ambiri okhudzana ndi thanzi kusiyana ndi anthu ambiri a ku America ndipo, chifukwa chake, adzafunika kuwonanso ma EBs ndi madola azachipatala.
Njira Zodulira
Mapulani a zaumoyo, makampani olipirira zachipatala, ndi othandizira zaumoyo amagwiritsa ntchito machitidwe osiyanitsa katatu. Zizindikiro izi zinakhazikitsidwa kuti zitsimikizire kuti pali njira yodalirika ndi yodalirika ya makampani a inshuwalansi azaumoyo kuti akwaniritse chithandizo kuchokera kwa ogwira ntchito zaumoyo ndi kulipira mautumiki a zaumoyo.
Makhalidwe Amakono Otsatira
Machitidwe amasiku ano omwe ali ndi machitidwe (CPT) amagwiritsidwa ntchito ndi madokotala kufotokoza zomwe amapereka. Dokotala wanu sangathe kulipiritsa ndondomeko yanu yazaumoyo pokhapokha ndondomeko ya CPT idalembedwa pa fomu yodzinenera.
Makalata a CPT apangidwa ndi kusinthidwa ndi American Medical Association (AMA). Mwamwayi, AMA siyikutsegula mauthenga a CPT momasuka. Amalonda a zamankhwala omwe amagwiritsira ntchito zizindikirozo ayenera kugula mabuku olembetsa kapena kupeza ma intaneti kuchokera ku AMA.
Malo AMA amakulolani kuti mufufuze khodi kapena dzina la ndondomeko. Komabe, bungwe limakulepheretsani kuti musapitirize kufufuza zisanu pa tsiku (muyenera kupanga akaunti ndi kuinaina kuti mugwiritse ntchito kufufuza). Komanso, dokotala wanu akhoza kukhala ndi pepala (lotchedwa mawonekedwe okumana nawo kapena "zokongoletsera") omwe amalembetsa ma CPT ambiri komanso zizindikiro zomwe zimagwiritsidwa ntchito muofesi yake. Ofesi yanu ya udokotala akhoza kukugawanizani fomuyi.
Zitsanzo zina za zizindikiro za CPT ndi izi:
- 99201 - ofesi kapena wodwala kupita kuchipatala kukayezetsa ndi kuyang'anira wodwala watsopano
- 93000 - electrocardiogram
- 36415 - Magazi a mitsempha yowonongeka (kuchotsa magazi)
Njira Yogwiritsira Ntchito Njira Zogwiritsira Ntchito Umoyo Wodalirika
Bungwe la Healthcare Common Procedure Coding System (HCPCS) ndi njira yokhala ndi coding ntchito ya Medicare.
Ma Code Level HCPCS ndi ofanana ndi ma CPT ochokera ku American Medical Association.
Medicare imasungiranso malemba omwe amadziwika kuti HCPCS mlingo wachiwiri. Zizindikirozi zimagwiritsidwa ntchito podziwa zinthu, mapulogalamu, ndi mautumiki omwe sali nawo mapepala a CPT, monga ma ambulansi ndi zipangizo zamankhwala zokhazikika (ma wheelchairs ndi mabedi a chipatala), ma prosthetics, orthotics, ndi zinthu zomwe zimagwiritsidwa ntchito kunja kwa ofesi yanu.
Zitsanzo zina za zigawo za HCPCS zapakati paziwiri ndi izi:
- L4386 - kuyenda kuyenda
- E0605 - vaporizer
- E0455 - hema wa oxygen
Centers for Medicare ndi Medicaid Services imasunga webusaitiyi komwe mauthenga atsopano a HCPCS amapezeka kwa anthu onse.
Mitundu Yonse ya Matenda
Mchitidwe wachitatu wa kuwerengera ndi Maiko Akumayiko a Matenda, kapena ma code ICD. Zizindikiro izi, zopangidwa ndi World Health Organization (WHO), zimatengera thanzi lanu, kapena matenda. Zizindikiro za ICD zimagwiritsidwa ntchito potsata ndondomeko za CPT kuti mutsimikizire kuti thanzi lanu ndi mautumiki omwe munalandira akugwirizana.
Mwachitsanzo, ngati matenda anu ali ndi bronchitis ndipo dokotala wanu adalamula X-ray, amatha kukhala ndi X-ray chifukwa sichigwirizana ndi bronchitis. Komabe, chifuwa cha X-ray n'choyenera ndipo chiyenera kubwezeredwa.
Zitsanzo zina za zizindikiro za ICD-10 ndi izi:
- E66.0 - kunenepa kwambiri chifukwa cha kuchuluka kwa zopatsa mphamvu
- F32.0 - kuvutika maganizo
- S93.4 - zokhala ndi mitsempha
Mndandanda wathunthu wa zizindikiro za matenda (zomwe zimadziwika kuti ICD-10) zimapezeka kuti zimasulidwe kuchokera ku webusaiti ya CMS, ndipo ICD10data.com imapanga molunjika pofufuza zizindikiro zosiyanasiyana.
Ambiri a US adasinthidwa kuchokera ku ICD-9 mpaka ICD-10 malemba mu 2015, koma machitidwe ena onse a masiku ano a zaumoyo adayendetsa ntchito ICD-10 zaka zambiri kale. Zizindikiro za CPT zikupitiriza kugwiritsidwa ntchito mogwirizana ndi zizindikiro za ICD-10 (zonsezi zikuwonetsa madokotala), chifukwa zizindikiro za CPT ndizolipira, pamene ma ICD-10 ali ndi zolemba zolembera.
Kulemba Zolakwika
Kugwiritsa ntchito njira zitatuzi zolemetsa zingakhale zolemetsa kwa ogwira ntchito kuchipatala komanso otanganidwa ndi opaleshoni ndipo n'zosavuta kumvetsetsa chifukwa chake zolakwika zikuchitika. Chifukwa dongosolo lanu la thanzi limagwiritsira ntchito zizindikiro kupanga ndalama zogulira dokotala wanu ndi ena othandizira zaumoyo, zolakwa zingakuwonongereni ndalama.
Nkhosa yolakwika ikhoza kunena kuti muli ndi vuto la thanzi limene mulibe ( pakadalibe nkhawa zomwe zakhalapo kale zikanakhala zolepheretsa kupeza chithandizo chaumoyo pansi pa ntchito ya kusintha kwa chisamaliro cha GOP), perekani ndalama zambiri kwa dokotala wanu ndipo mwinamwake mungakweretse ndalama zanu zongotuluka , kapena ndondomeko yanu yaumoyo ingakane zomwe mumanena ndipo musapereke kalikonse. N'zotheka kwa dokotala wanu, chipinda chodzidzimutsa, kapena chipatala kuti musamalowetsedwe mautumiki omwe mwalandira, mwina kulemba zolakwika zolakwika kapena njira zolakwika. Ngakhale zophweka zosavuta zolemba zingakhale ndi zotsatira zofunikira.
Mwachitsanzo: Doug M. adagwa akuyenda. Chifukwa cha ululu m'chiuno chake, anapita ku chipinda chake chodzidzimutsa. Atapanga X-ray ya mchiuno, dokotala wa ER anapeza chipinda cham'mimba ndipo anatumiza nyumba ya Doug kuti apumule. Patangopita milungu ingapo Doug adalandira ndalama kuchokera kuchipatala kwa ndalama zoposa $ 500 pa X-ray. Pamene EOB yake ifika, adawona kuti ndondomeko yake yathanzi idakana chidziwitso cha X-ray.
Doug anatcha dongosolo lake la thanzi. Zinatenga kanthawi kukonza cholakwika chomwe chinapangidwa ndi wolemba ndalama kubwalo lachangu. Mwadzidzidzi anaika nambala yolakwika m'ndondomeko ya Doug yodzitetezera, kusintha S93.4 (kabokosi kameneka) ku S53.4 (golide wopopera). Ndondomeko ya zaumoyo ya Doug inakana chigamulo chifukwa chakuti X-ray ya mkondo siyeso yomwe imachitika ngati wina ali ndi chovulala cha mmutu.
Pali zochitika zingapo pakukonzekera ndikupereka chithandizo chachipatala. Ali panjira, anthu ndi makompyuta omwe akugwira ntchitoyi akhoza kulakwitsa. Ngati malingaliro anu atanidwa, musachite manyazi kutchula ofesi ya dokotala ndi dongosolo lanu la thanzi.
> Zotsatira:
> American Medical Association. Kupeza Zowonjezera Zida.
> Bohnett, Charlotte. WebPT. Zinthu 8 Zomwe Muyenera Kudziwa Tsopano Zokhudza ICD-10. July 2013.
> Magulu a Medicare ndi Medicaid Services. HCPCS Kutsiriza Kwaiyezi.
> ICD10data.com. Webusaiti Yopanda Free 2018 ICD-10-CM / PCS Medical Coding Reference.