Zomwe Zimayambira Kulipirira Zamankhwala

Zimene Mukuyenera Kudziwa Pamene Mukufufuza Ntchito za Wolemba Zamankhwala

Amalonda a zachipatala amachititsa kuti pulogalamu yamakono kapena akatswiri azachipatala adziwe kwa makampani a inshuwalansi monga maofesi a udokotala, zipatala, nyumba zaukhondo, kapena zipatala zina. Mu chipatala , ndalama zamalonda zimagwira ntchito zosiyanasiyana kusiyana ndi ndalama zamalonda zomwe zimagwira ntchito zina.

Ngati mukufuna kuti mukhale wogulitsa zamankhwala, izi ndizofunikira zokhudzana ndi kulipira kwachipatala, olipidwa akuluakulu, ndi momwe amachitira.

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Mfundo Zowonjezera Za Inshuwalansi Zaumoyo

Kumvetsetsa zofunikira za inshuwalansi zaumoyo zimathandiza ogwira ntchito ku ofesi kuntchito kuti alankhulane bwino ndi odwala za inshuwalansi za umoyo wawo ndi kukambirana nawo nkhani za odwala ndi oimira inshuwalansi.

Kukhala ndi chidziwitso chachikulu cha mtundu uliwonse wa inshuwalansi kungachepetse mavuto okhudza kufotokozera malingaliro ndi kusonkhanitsa malipiro. Pali mitundu iwiri ikuluikulu ya mapulani a inshuwalansi:

1. Inshuwalansi yowonjezera: Malipiro a msonkho
2. Ndondomeko Zosamalidwa
   • Mabungwe Omwe Amasamalira Odwala (HMOs)
   • Mabungwe Opereka Othandizira (PPOs)
   • Makampani Odzipereka Okhaokha (EPOs)
   • Mapulani a Point-of-Service (POS)

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Ndondomeko Za Zaumoyo za Boma

Ine ndikukuuzani : Medicare ndi pulogalamu ya federal yomwe imapereka chithandizo chaumoyo kwa anthu oposa 40 miliyoni a ku America omwe akuphatikizapo:

• okalamba oposa zaka 65
• olumala kosatha akuluakulu osakwana zaka 65
• Anthu omwe amavutika ndi Matenda Otha Kudwalitsa (ESRD) omwe amatha kusokonezeka kwa impso zomwe zimafuna dialysis kapena kupsyinjika kwa impso.

Medicaid : Ndikofunikira kukumbukira kuti Medicaid si inshuwalansi. Medicaid ndi pulogalamu yomwe imapereka chithandizo cha mankhwala m'malo mwa wolandira.

Ngati udindo wachitatu ulipo, ndiye Medicaid nthawi zonse amalipira malipiro omaliza. Izi zikutanthauza kuti Medicaid nthawi zonse amalipira nthawi yomwe inshuwalansi ilipo.

TRICARE: TRICARE, yemwe ali m'gulu la Military Health System lomwe limayendetsedwa ndi Dipatimenti ya Chitetezo (DoD), ndi ntchito yothandizira anthu odwala, ogwira ntchito pantchito komanso anthu ogwira nawo ntchito.

CHAMPVA: Ngakhale kuti ndi ofanana ndi TRICARE, CHAMPVA imayang'aniridwa ndi Dipatimenti ya Veterans Affairs, ndipo ngati wina ali woyenera ku TRICARE sangathe kulandira CHAMPVA. Zonse TRICARE ndi CHAMPVA nthawi zonse zimakhala zachilendo ku Mapulani a Inshuwalansi za Umoyo osati pulogalamu yowonjezera ndi Medicaid.

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Ndondomeko Yopereka Udokotala

Kuloledwa kwa odwala: Pomwe odwala akulowetsa, odwala matenda odziŵitsa odwala amalowa, kuphatikizapo inshuwalansi, nambala ya ndondomeko, ndi zina zowonjezera kuti athetse chiyero choyera.

Kuvomerezeka ndi inshuwalansi : Chifukwa chakuti inshuwalansi imatha kusintha nthawi iliyonse, ngakhale kwa odwala nthawi zonse, nkofunika kuti wothandizira atsimikizire kuti wothandizirayo ali woyenera nthawi zonse mautumiki aperekedwa. Gawoli la ndondomekoyi ndilofunika kuti mulandire uthenga wothandizira ndi ubwino.

Kulowetsa Malipiro : Kulowa malipiro ndizolowera kwa ndalama zomwe zimaperekedwa kwa wodwalayo ndipo zimaphatikizapo kulumikizana koyenera kwa zizindikiro zachipatala kwa mautumiki ndi njira zomwe zimaperekedwa pamene odwala akuchezera.

Kulembera kafukufuku, ndondomeko, ndi kusintha : Zolemba zamakalata zimapangitsa wogulitsa inshuwalansi kudziwa matenda kapena kuvulala kwa wodwala komanso njira ya chithandizo.

Kugonjetsedwa kwa malonda : Pambuyo pempholi litamaliza, pempholo limaperekedwa kuti lilipereke kwa wothandizira inshuwalansi. Kuti apereke chigamulo choyenera cha zamankhwala, ndalama zamalonda zimayenera kudziwa kapena kupeza zambiri zambiri kwa kampani iliyonse ya inshuwalansi.

Kulemba malipiro: Kulemba malipiro kumaphatikizapo kutumiza ndi kuika ntchito ndi kubwezeretsa ntchito zolemba ndi ndalama.

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Billing Billing ndi Institutional Billing

Mu kulipira kwachipatala, pali mitundu iwiri yolipira - bizinesi yothandizira ndi kulipira ngongole.

Malipiro a Professional: Kulipira ngongole kumalonda kumachititsa kulipira kwazinenezi zomwe zaperekedwa kuntchito zochitidwa ndi madokotala, ogulitsa katundu ndi ena omwe si omwe amapereka chithandizo kwa onse odwala komanso opaleshoni. Malipiro a zamalonda amalembedwa pa fomu ya CMS-1500. CMS-1500 ndi inki yofiira pa fomu yoyera yomwe amaimira fomu yomwe amagwiritsidwa ntchito ndi madokotala ndi ogulitsa katundu chifukwa cholipira ngongole.

Billing Institutional: Kubhadwa kwemahofisi kunokonzera kubhadhara zvikwereti zvinokonzerwa nebasa rakagadzirwa nezvipatara, vanamukoti vane unyanzvi, nedzimwe nzvimbo dzekurapa uye zvekuchera varwere, kusanganisira kushandiswa kwezvigadzirwa uye zvigadzirwa , mabhizinesi, mabasa ehudhiology, nezvimwewo. Milandu ya boma imayikidwa pa UB-04. Bungwe la UB-04 ndi inki yofiira pa pepala loyera lomwe likuyimira fomu yomwe imagwiritsidwa ntchito ndi omwe amapereka chithandizo pamalopo.

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Billing Billing ndi Paper Claim Claiming

Kulipira pepala sikuli kusankha koyamba kubweza ngongole koma nthawi zina ntchito yofunikira. N'zoona kuti njira zamakanema zamagetsi zimakhala zosavuta komanso mofulumira poyerekezera ndi ndondomeko yoyendetsera mapepala.

Ambiri omwe amapereka inshuwalansi akuluakulu amapereka kupereka kwa magetsi. Muli ndi kusankha kolipira molunjika kapena kukhazikitsa akaunti ndi nyumba yosungiramo zinthu.

Nyumba yosungiramo zitsulo ndi kampani yomwe ingavomereze zonse zomwe mumanena ndikugwiritsira ntchito pulogalamu yamakono kupita nawo ku inshuwalansi omwe akulipira. Akonzanso m'malo kuti awone zolakwika muzomwe mumanena kuti zingakuthandizeni kupeŵa kuchedwa kwa kulipira.

Phindu lalikulu la kubwezera pakompyuta ngati mumagwiritsa ntchito nyumba yosungiramo zinthu zowonongeka kapena mukulipira ngongole kuti muthamangitse malingaliro anu. Kulipira mapepala kungatenge masiku makumi asanu ndi awiri kuti agwiritsidwe ntchito.

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Medical Office Terminology

Mufuna kudziwa bwino mawu awa okhudzana ndi inshuwalansi ya umoyo, kulipira kwachipatala, zolembera zachipatala, zamakono zamakono, ndi zamakono zamakono.

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Kusamalidwa kwa Zamankhwala Zamankhwala

Muyenera kumvetsetsa ndalama zogulira zamagetsi ndi mawonekedwe apakompyuta, omwe amavomerezedwa ndi Medicare, Medicaid, ndi makampani ambiri a inshuwalansi. Komabe, ziwerengero za kulipira mapepala zimakhalabepo ndipo muyenera kudziwa kuti mukuzikonza.

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Kulipiritsa zamankhwala kwa Medicare, Medicaid, ndi Tricare

Obwezera a boma awa ndi gawo lofunika la kulipira kwachipatala. Muyenera kudziwa bwino njira zawo. Fufuzani aliyense payekha, komanso ena mwa makampani akuluakulu a inshuwalansi.

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