Ama-ASC Billing Basics

Ukukhokhwa Kwezimangalo Zokuhlinzeka Ngokuhlinzeka Ngokuhlinzwa

Isikhungo Sokuhlinzeka Ngesivinini (ASC) sichazwa yi-CMS njengesikhungo ngenhloso yodwa yokuhlinzeka ngeziguli zokuhlinzeka ngeziguli. Izikhungo zokuhlinzeka ngezidakamizwa zingabonakala ngenhlangano esekelwe esibhedlela noma ingaba isikhungo sokuhlinzeka ngeziguli eziphuthumayo.

Ngenkathi izimangalo ze-ASC zinezici ezithile ezibhekene nezicelo zesibhedlela uma kuziwa ekukhokheleni, kunemibono ehlukile kakhulu.

Amafomu Wokumangalelwa kwe-ASC - Okumele uwasebenzise

Izimangalo zesikhungo sokuhlinzeka ngeziguli zifakwe eMedare, Medicare Advantage Plans, neMedicaid kwi-HCFA 1500 noma i-837P. Lokhu kuhluke ekuhlinzekeni kwabangaphandle kwezibhedlela kubangakhokheli, okufakwe ku-UB-04 noma i-837I.

I-CMS-1500 yi-inkino ebomvu ephepheni elimhlophe lefomu lokumangala elisetshenziswe odokotela nabahlinzeki ngokukhokhiswa kwesicelo. Noma yikuphi umhlinzeki ongenazikhungo nomhlinzeki angasebenzisa i-CMS-1500 izimangalo zezokwelapha zokukhokha. Inguqulo ye-elektroniki ye- CMS-1500 ibizwa ngokuthi i-837-P, i-P imele ifomethi yobuchwepheshe.

I-UB-04 noma i-837-I isetshenziswa yi-ASCs ukufaka izicelo zezokwelapha kubo bonke abanye abakhokha.

Okuningi

Uhlobo lweBill for ASC

Uma uhambisa izimangalo ku-UB-04, uhlobo lwe-bill yezimangalo ze-ASC luyi-83X.Idijithali yokuqala ibhekisela kuhlobo lwesakhiwo: 8 - Isikhungo Sokukhethekile, Isikhungo Sezokwelapha Se-ASC Idijithi yesibili ibhekisela kuhlelo lokukhokha: 3 - Isiguli

Idijithi yesithathu ibhekisela kumvamisa omelelwe ngenhla nge-X variable.

1 - Thumela ngokuKhipha isimangalo

7 - Ukufaka isicelo seSimangalo esandulele noma isimangalo sokulungiswa

8 - Kungavumelekile noma Khansela Ngaphambi Kokumangalelwa Okungaphambili

I-Revenue Code

Lapho uhambisa izimangalo ku-UB-04, ikhodi yezimali engenayo esetshenziselwa ukubika izinqubo zokuhlinzeka ngezikhungo zokuhlinzeka nge-ambulatory is 490.

Ukusetshenziswa Kwezinguquko

Izimangalo ze-ASC zingaba yinto edidekayo ngoba abakhokheli abahlukene abadingi nje kuphela izinhlobo ezahlukene zamafomu okufaka izicelo, futhi badinga ukusetshenziswa kwezinguquko ezihlukile.

Abagulayo beMedare

I-Medicare idinga ukuguqula okulandelayo uma ufaka amakhodi amakhodi athile we-ASC izimangalo:

Ushintsho RT - Uhlangothi lwesokudla (olusetshenziselwa ukukhomba izinqubo ezenziwe ngakwesokudla komzimba)

I-Modifier LT - Uhlangothi lwesobunxele (olusetshenziselwa ukubona izinqubo ezenziwe ngakwesokunxele komzimba)

Ishintsho se-TC- Isici sezobuchwepheshe

Ishintsho 52 - Izinsizakalo ezincishisiwe

Ishintsho 59 - Inqubo ehlukile ehlukile

Ishintsho 73 - Inqubo ekhishiwe ngemuva kokulungiselela ukuhlinzwa

Ishintsho 74 - Inqubo ekhishiwe ngemuva kokubulawa kwe-anesthesia

I-Modifier FB - Idivayisi inikezwe ngaphandle kwezindleko / isikweletu esigcwele

I-Modifier FC - Idivayisi inikezwe ngesikweletu esikhethekile

I-modifier PA - Ingxenye yomzimba engalungile

I-Modifier PB - Isiguli esilungile isiguli

I-PC Modifier - Ukuhlinzeka okungalungile ngesiguli

I-Modifier PT - Ukuhlolwa okubukeka kahle okuguqulwa kuhlelo lokuxilonga noma lwezokwelapha / ukuhlinzwa

I-Modifier GW - Ukuhlinzwa akuhlobene nokugula kwezigulane zeziguli

I-Medicaid Modifier

Ngisho noma i-Medicare isebenzisa lezi zinguquko, i-Medicaid ayidingi ukusetshenziswa kwanoma yikuphi kwalokhu. I-modifier kuphela evumelekile ye-Medicaid i-modifier SG ehlukanisa isimangalo njengesimangalo sokuhlinzekwa isikhungo sokuhlinzekwa.

Kudingeka ukufaka i-modifier SG kuyo yonke ikhodi ye-CPT kungakhathaliseki ukuthi ukhokha ukuze ahlukanise ukukhokhiswa kusukela ekufuneni okusemthethweni kwesevisi efanayo.

Amanye ama-Modifier Assurer

Esinye isibonelo somthelela ekusetshenzisweni kwe-modifiers ukuthi i-Blue Cross Blue Shield ** idinga ukusebenzisa i-modifier 50, ehlukanisa inqubo njengendlela yokubambisana, nezinyathelo ezimbili zesevisi. Ngakolunye uhlangothi, i-Medicare idinga i-modifier 50 noma i-RT yomhleli kanye ne-LT emigqeni ehlukene neyunithi yesevisi.

** Imihlahlandlela yokukhokha ingahlukana ngombuso. Hlola ngencwadi yezwe ye-BCBS ukuze uthole.