Amaphutha ekuCoding angakubiza Imali
Amakhodi omshuwalense asetshenziswa uhlelo lwakho lwezempilo ukwenza izinqumo mayelana nokuthi kufanele ukhokhe kangakanani udokotela wakho nabanye abahlinzeki bezempilo. Ngokujwayelekile, uzobona lezi zimakhodi ekuchazweni kweziNzuzo kanye nezikweletu zezokwelapha.
Incazelo Yezinzuzo (EOB) ifomu noma idokhumenti engathunyelwa kuwe yinkampani yakho yomshuwalense amasonto ambalwa noma izinyanga ngemuva kokuba unakekelo lwezempilo olwakhokhelwa yinkampani yomshuwalense.
I-EOB yakho iyindiza emlandweni wakho wokukhokha kwezokwelapha. Buyekeza ngokucophelela ukuze uqiniseke ukuthi empeleni uthola insizakalo ekhokhwayo, inani othola udokotela wakho kanye nesabelo sakho silungile, nokuthi ukuxilongwa kwakho nenqubo yakho kubhalwe kahle futhi ikhodiwe.
Okubalulekile Amakhodi Omshwalense
Ama-EOB, amafomu okufaka umshwalense, kanye nezikweletu zezokwelashwa ezivela kudokotela wakho noma esibhedlela kungaba nzima ukuyiqonda ngenxa yokusetshenziswa kwamakhodi ukuchaza izinsizakalo ezenziwe kanye nokuxilongwa kwakho. Lezi zimakhombo zivame ukusetshenziselwa esikhundleni se-English ecacile futhi kungase kube usizo kuwe ukuthi ufunde ngalezi zimakhodi, ikakhulu uma unenkinga eyodwa noma ngaphezulu engokwempilo.
Isibonelo, izigidi zaseMelika zifake isifo sikashukela sesi-2 kanye nomfutho wegazi ophezulu kanye ne-cholesterol ephezulu. Leli qembu labantu kungenzeka ukuthi libe nezinsizakalo zezempilo ezingaphezu kwe-American average, ngakho-ke, kuzodingeka zibuyekeze ama-EOB amaningi kanye nezikweletu zezokwelapha.
Izinhlelo Zokukhokhwa
Amalungiselelo ezempilo, izinkampani zokukhokha ezempilo, kanye nabahlinzeki bezempilo basebenzisa izinhlelo ezintathu zokubhala izinhlu ezahlukene. Lezi zimakhodi zakhiwe ukuqinisekisa ukuthi kunendlela ehambisanayo neyokwethenjelwa yezinkampani zomshuwalense wezempilo ukucubungula izimangalo ezivela kubahlinzeki bezempilo bese ukhokhela izinsizakalo zezempilo.
I-terminology yamanje yezinqubo
Amakhodi wamanje we-Procedural Terminology (CPT) asetshenziswa odokotela ukuchaza amasevisi abanikezayo. Udokotela wakho ngeke akhokhelwe uhlelo lwakho lwezempilo ngaphandle kokuba ikhodi ye-CPT ibhalwe efomini lesimangalo.
Amakhodi we-CPT akhiwa futhi abuyekezwa yi-American Medical Association (AMA). Ngeshwa, i-AMA ayinikezi ukufinyelela okuvulekile kumakhodi we-CPT. Abadayisi bezokwelapha abasebenzisa amakhodi kumele bathenge izincwadi zokubhala noma ukufinyeleleka kwi-intanethi kumakhodi avela ku-AMA.
Indawo ye-AMA ikuvumela ukuthi ufune ikhodi noma igama lenqubo. Noma kunjalo, inhlangano ikuvimbela ukuthi ungaphinde ufune ukusesha okungu-5 ngosuku (kufanele wenze i-akhawunti bese ungena ngemvume ukuze ukwazi ukusebenzisa isici sokusesha). Futhi, udokotela wakho angase abe neshidi (elibizwa ngokuthi ifomu lokuhlangana noma "ukukhwabanisa") obala i-CPT ejwayelekile kakhulu kanye namakhodi okuxilongwa asetshenziswe ehhovisi lakhe. Ihhovisi lakho lodokotela lingabelana ngale fomu nawe.
Ezinye izibonelo zamakhodi we-CPT yi:
- I-99201 - ihhovisi noma esinye isiguli sokuvakashela ukuhlolwa nokuphathwa kwesiguli esisha
- 93000 - electrocardiogram
- I-36415 - iqoqo legazi elimnyama ngokuthunjwa (ukudweba igazi)
Uhlelo Lokusebenza Oluhlelekile lwezokuChumana
Uhlelo lweCoding Common Procedure Coding System (HCPCS) uhlelo lwekhowudi olusetshenziswa yi-Medicare.
Amakhodi we-Level I HCPCS afana namakhodi we-CPT avela ku-American Medical Association.
I-Medicare ibuye igcine iqoqo lamakhodi eyaziwa njengeHCPCS Level II. Lezi amakhodi asetshenziselwa ukukhomba imikhiqizo, izimpahla, nezinsizakalo ezingafakiwe kumakhodi we-CPT, njengezinsizakalo ze-ambulensi nemishini yokwelashwa eqinile (izihlalo zabakhubazekile nemibhede yesibhedlela), izifo zokuzivikela, izintambo, kanye nezinto ezisetshenziswa ngaphandle kwehhovisi lakho lodokotela.
Ezinye izibonelo zamazinga we-Level II HCPCS yizi:
- L4386 - ukuhamba ngokugqamile
- I-E0605 - i-vaporizer
- E0455 - itende le-oxygen
Amasevisi we-Medicare ne-Medicaid Services agcina iwebhusayithi lapho ulwazi olusha olusha lwe-HCPCS lukhona khona emphakathini.
Ukuhlukaniswa Kwezifo Zomhlaba Wonke
Uhlelo lwesithathu lwekhodi lokubhala yi-International Classification of Diseases, noma ama-ICD amakhodi. Lezi zimakhodi, ezakhiwe yi-World Health Organization (WHO), zikhomba isimo sakho sezempilo, noma ukuxilongwa. Ama-ICD amakhodi asetshenziselwa ukuhambisana namakhodi we-CPT ukuqinisekisa ukuthi isimo sakho sezempilo kanye nezinsizakalo ozitholile zifanelana.
Isibonelo, uma uhlolisiswa yi-bronchitis kanti udokotela wakho wayala i-X-ray ye-ankle, kungenzeka ukuthi i-X-ray ngeke ikhokhwe ngenxa yokuthi ayihlobene ne-bronchitis. Kodwa-ke, i-X-ray esifubeni iyadingeka futhi izobuyiselwa.
Ezinye izibonelo zamakhodi we-ICD-10 ziyi:
- I-E66.0 - ukukhuluphala ngokweqile ngenxa yamakholori amaningi
- F32.0 - ukucindezeleka okuncane
- I-S93.4 - i-ankle ehlutshiwe
Uhlu oluphelele lwamakhodi wokuhlonza (owaziwa njenge-ICD-10) lutholakala ukulanda kusuka kuwebhusayithi ye-CMS, futhi i-ICD10data.com yenza kube ngokuqondile ukucinga amakhodi ahlukahlukene.
I-US ishintshiwe kusukela kuma-ICD-9 kuya kuma-ICD-10 amakhodi ngo-2015, kodwa zonke izinhlelo zokunakekelwa kwezempilo zanamuhla zenze uhlelo lwe-ICD-10 eminyakeni eminingi ngaphambili. Amakhodi we-CPT aqhubeka asetshenziswa ngokubambisana namakhodi we-ICD-10 (boba bobabili babonisa izimangalo zezokwelapha), ngoba amakhodi we-CPT aqondene nokukhokhisa, kanti amakhodi we-ICD-10 angokomqulu wokuxilongwa.
Iziphambeko zekhodi
Ukusebenzisa lezinhlelo ezintathu zokukhokhisa kungaba nzima kunomsebenzi odokotela nodokotela osebenzayo futhi kulula ukuqonda ukuthi kungani amaphutha okukhokha ekhona. Ngenxa yokuthi uhlelo lwakho lwezempilo lusebenzisa amakhodi ukwenza izinqumo mayelana nokuthi kufanele ukhokhe kanjani udokotela wakho nabanye abahlinzeki bezempilo, amaphutha angakubiza imali.
Ikhodi engalungile ingakubiza ngokuthi unempilo ehlobene nalokho ongenayo (kusenokukhathazeka ukuthi izimo ezikhona ngaphambili zingase zibe yisithiyo ekutholeni ukuhlolwa kwezempilo ngaphansi kwemizamo yokuguqulwa kwempilo ye-GOP), kubangele ukukhokhelwa ngokweqile kudokotela wakho futhi kungenzeka ukwandise izindleko zakho ezingaphandle kwe-pocket , noma uhlelo lwakho lwezempilo lungaphika isimangalo sakho futhi ungakhokhi lutho. Kungenzeka udokotela wakho, igumbi lokuphuthumayo, noma isibhedlela ukungahambisani nezinsizakalo ozitholile, noma ukubhala ukuxilongwa okungalungile noma izinqubo ezingalungile. Ngisho namaphutha we-typographical alula angaba nemiphumela ebalulekile.
Isibonelo: UDoug M. wawa ngenkathi egijima. Ngenxa yobuhlungu ekhanda lakhe, waya ekamelweni lakhe lokuphuthumayo. Ngemva kokuthola i-X-ray ye-ankle yakhe, udokotela we-ER wathola i-ankle ehlongoziwe futhi wathumela ikhaya likaDoug ukuze aphumule. Ngemva kwamasonto ambalwa uDoug wathola isimemezelo esibhedlela esibhedlela esingaphezu kuka-$ 500 esikhwameni se-X-ray. Lapho i-EOB yakhe ifika, yaqaphela ukuthi uhlelo lwakhe lwezempilo lwalunqabe isimangalo se-X-ray.
UDoug wabiza uhlelo lwakhe lwezempilo. Kwasithatha isikhashana ukulungisa iphutha elenziwe yibhalisi lokukhokha ekamelweni eliphuthumayo. Uvele wabeka inombolo engalungile ku-Doug's diagnosis code, eshintsha i-S93.4 (i-ankle ehlutshiwe) eya ku-S53.4 (i-elbow sprained). Uhlelo lwezempilo lukaDoug lwenqabe isimangalo ngoba i-X-ray ye-ankle ayiyona into eyenziwa uma umuntu enobungozi be-elbow.
Kunezinyathelo eziningana ekwenzeni ukugcwalisa nokuthumela isimangalo sezokwelapha. Ngendlela, abantu namakhompiyutha abathintekayo kule nqubo bangenza amaphutha. Uma ngabe isimangalo sakho senqatshiwe, ungabi namahloni ngokubizela ihhovisi lakho nodokotela kanye necebo lakho lempilo.
> Imithombo:
> American Medical Association. Ukuthola Resources Resources.
> Bohnett, uCharlotte. I-WebPT. 8 Izinto Okudingeka Uzazi Manje Mayelana ne-ICD-10. Julayi 2013.
> Amasevisi e-Medicare naseMedicaid Services. Ukuvuselelwa kwekota kwe-HCPCS.
> ICD10data.com. I-Free Web 2018 ye-ICD-10-CM / PCS ye-Coding Reference Reference.