Imali yokukhokhisa i-Medicare ayifanele kubangele ukulahla nokuphika okuningi uma unolwazi olufanele lwemikhombandlela yokukhokha yeMedare. Ulwazi oluhlinzekwe ngezansi yilokho okwenziwayo nokungenzi lutho oluvame ukuvimbela amaphutha okukhokha.
Ungakhohlwa ukuvakashela iwebhusayithi ye-CMS ukuze uthole amathrekhi okufinyelela emisebenzi, izinkombandlela, kanye nezincwadi ezingasiza kakhulu ekukhokhweni kwemithi efanele.
Okuzokwenzela Ukukhokhwa Kwezokwelapha
Ikhodi ikhomba ngendlela efanele ngokusekelwe ezinsizeni, ukuhlolwa, nezinqubo ezenziwe.
Yenza irekhodi lerekhodi yezokwelapha ngezincazelo eziqondile kuzo zonke izinsizakalo, izivivinyo, kanye nezinqubo ezenzelwe kahle futhi zilandele ngokwanele izimpawu zesiguli, izikhalazo, izimo, izifo nokulimala.
Ingabe ubika amakhodi wenqubo ye - CPT / HCPCS ku-Medicare ukuthi ihambisana kakhulu nemibhalo emrekhodini wezokwelapha.
Khetha bese ubika ama-modifiers afanele kumakhodi we-CPT / HCPCS esimangalo ngokwemigomo ye-Medicare.
Ingabe uhlanganisa ubude besikhathi, imvamisa yokwelashwa, noma inombolo yamayunithi kwirekhodi yezokwelapha ukubika okunembile mayelana nesimangalo.
Ingabe ubike amakhodi wokuxilongwa kwe-ICD-9 ezingeni eliphakeme kakhulu lezimpawu ezihambisana nezimpawu zesiguli, izikhalazo, izimo, izifo nokulimala okuningiliziwe kwirekhodi yezokwelapha.
Ingabe ufaka izimangalo kungakapheli unyaka owodwa wosuku lwensizakalo ye-Primary Medicare kanye nezimangalo ze-MSP.
Ingabe ubika izingxenye zezinsizakalo ezisekelwe ku-National Correct Coding Initiative (NCCI) kanye nokuhlelwa okungaqondakali komuthi (AMUEs) ukuvimbela ukubika izinsizakalo eziningi noma izinqubo ezingafanele zikhokhiswe ndawonye ngoba inkonzo eyodwa noma inqubo kungenzeka ukuthi ihlanganisa enye noma ngoba kungenakwenzeka ukuthi kwenziwe ngesiguli esifanayo ngosuku olufanayo.
Iba nesaziso se- Advance Beneficiary Notice (ABN) efayeleni ukuze ubhale kahle izinsizakalo ezingabonwayo ne-modifier efanele, okungukuthi i-GA noma i-GZ, ezokhomba izinsizakalo ezingakhokhiswa noma zingakhokhiswa isiguli.
Uthola isignesha kusuka isiguli isigunyaza isabelo izinzuzo, evumela umhlinzeki ukuthola imvume, futhi ukuhlinzeka ukunakekelwa.
Qinisekisa ukufaneleka kwesiguli kuFayili Yokusebenza Ejwayelekile (CWF) ngaphambi kokukhokhisa isimangalo ukuqinisekisa ukuthi ulwazi lomguli aluzange lushintshe.
Okungafanele Ukwenzele Ukukhokhwa Kwemithi Yezokwelapha
Ungakhokhisi nganoma yiluphi usizo, ukuhlolwa, noma inqubo eyenziwa uma kungekho imibhalo yezimpawu, izikhalazo, izimo, izifo, nokulimala okunikeza ubufakazi ngaphandle kokuba ikhodi yokuhlola isetshenziswe.
Ungabika amakhodi wenqubo ye-CPT / HCPCS engacacisiwe uma amakhodi athile we-CPT / HCPCS ayatholakala.
Ungafaki ngokuzenzekelayo ama-modifiers kuwo wonke ama-CPT / HCPCS uma irekhodi lezokwelapha lingasekeli ukusetshenziswa kwalo.
Ungayikhokhi izinsizakalo, izivivinyo noma izinqubo ezihlukile okufanele zihlanganiswe ndawonye ngoba zibhekwa njengezingxenye zenkonzo efanayo, ukuhlolwa noma inqubo.
Ungayikhokhisi izidakamizwa ezilawulwayo futhi uchithe ndawonye. Inani elilahlekile kufanele likhokhiswe emgqeni ohlukile futhi kuboniswe nge-JW modifier.
Ungathumeli izimali kuM Medicare ngenkokhelo uma isiguli sihlanganiswa nokuphathwa kweMedricare.
Ungathumeli izinkolelo zama-Venipunctures (36415) emangalo ye-Medicare Part B. Lokhu kungakhokhiswa njengengxenye yesimangalo esibhedlela.
Ungayikhokhisi ukuhlola okwenziwe ngokomzimba ngaphandle kokuthi ukhokhise ukuthola ukuphika. Uma ukukhokhiswa kokuphika, qiniseka ukuthi ungeze i-GY modifier kukhodi efanele yenqubo ye-CPT / HCPCS.
Ungazikhokheli izinsizakalo ze-Medicare Part B uma isiguli sikhethe i-Hospice yokwelashwa nokuphathwa kwesifo esibulalayo.
Ungathumeli izimangalo zephepha kunoma yini enye ngaphandle kwefomu ejwayelekile, ebomvu neyomhlophe ye-CMS-1500 noma ye-UB-04.