Isimangalo esifanele sincike ezintweni eziningi. Ukuhlala usesikhathini ekushintsheni kwamakhodi waminyaka yonke, ukulandela imihlahlandlela yokubhala ikhodi ejwayelekile futhi ukugcina amarekhodi ezinguli ezitholakala ngokugcwele kuyindlela elula yokuqinisekisa ukuthi izimangalo zezokwelapha zinembile.
Ukubhaliswa kwezimangalo ze-Medicare kunesidingo esiyingqayizivele sezidingo abahlinzeki abangabhekisela ekuvimbeleni ukuphikisana okuhlobene nekhodi noma izinkokhelo ezingafanele.
Leli setha lezidingo zekhowudi libizwa ngokuthi i-NCCI noma i-CCI inqubomgomo yamasevisi we-Medicare.
I-National Correct Initiative Initiative (NCCI) yasungulwa yiCenter of Medicare kanye neMedicaid Services (CMS) ukuvimbela izinkokhelo ezingafanele zeMedare ngenxa yamaphutha okubhala.
Kunezinhlobo ezintathu ze-NCCI ezihlelayo:
- Ukuhlelwa kwenqubo-kuya-inqubo
- Ukuhlelwa kwemithi okungenakwenzeka
- Ukwengezwa kwekhodi ikhodi
Ngokusho kwe-CMS, izinqubomgomo zokubhala ze-NCCI zinqunywe futhi zisekelwe enhlanganisweni yezinqubomgomo ezahlukene zokufaka ikhodi ezifaka:
- Umqulu we-Current Procedural Terminology (CPT) we-American Medical Association's (AMA)
- Izinqubomgomo zomphakathi zendawo kanye nezomphakathi
- Iziqondiso zomphakathi kazwelonke
- Izindlela zokwelapha ezivamile
- Imikhuba yekhowudi yamanje
Iwebhusayithi ye-CMS inikeza inamba yezibonelelo zabahlinzeki ngokubhala ngokunembile futhi ngokuqhubekayo izimangalo zempilo.
- I-National Correct Initiative for Initiative Coding Initiative Manual for Medicare Services
- I-NCCI ihlelwa ukusetshenziselwa izimangalo zomsebenzi
- I-NCCI ihlelwa ukusetshenziswa kwezimangalo zesibhedlela ezingaphandle kweziguli ku-Outpatient Code Editor (OCE)
- I-NCCI Imibuzo Ebuzwa Ngokujwayelekile (FAQ)
- Ukubuka konke kwe-MUE
- I-MUE Imibuzo Ebuzwa Ngokujwayelekile (FAQ)
- Amakhodi we-HCPCS / CPT anamanani we-MUE ashicilelwe kumathebula we-MUE we-Practitioner / DME
- Amakhodi we-HCPCS / CPT anamanani we-MUE ashicilelwe etafuleni le-MUE ye-Hospital Outpatient Services
- Amakhodi we-HCPCS / CPT anamanani we-MUE ashicilelwe ku-DUEABLE Equipment Equipment
- Izinguquko zamanje zenguqulo ye-version yezinguqulo ze-NCCI ezihlelwe futhi zanyatheliswa ama-MUEs
- I-Medicare Learning Network Ukushicilelwa: "Izinhlelo Zokubukezwa Kwemithi Ye-Medicare: MR, NCCI Ukuhlela, I-MUEs, CERT, kanye nokuHlola Uhlelo Lokuhlola"
- I-Medicare Learning Network Publication: "Indlela Yokusebenzisa I-National Correct Coding Initiative (NCCI) Amathuluzi"
I-NCCI: Ukuhlelwa Kwezinqubo Zokuhlela
Inqubo ye-NCCI yokuhlela inqubo isebenza kumakhodi womgomo we-CPT no-HCPCS.
Amakhodi we-CPT yiMikhodi Ejwayelekile Yomsebenzi futhi asethuthukiswa futhi agqanyiswa yi-American Medical Association ngo-1966. Lezi yizinhlelo zamakhodi ezinombolo eziyisihlanu ze-alphanumeric ezichaza ngendlela ejwayelekile yokwelashwa, yokuhlinzeka, nokuxilongwa.
I-HCPCS noma ama-System Care Cceding System Process Coding System ama-I no-II. Izinga lami linamakhodi we-CPT, futhi i-Level II ihlanganisa amakhodi alphanumeric asetshenziselwa ukukhomba imikhiqizo, ukuhlinzekela, kanye nezinsizakalo ezingafakiwe kumakhodi we-CPT uma zisetshenziswe ngaphandle kwehhovisi likadokotela.
Inqubo ye-NCCI yokuhlela-kuya-inqubo ivimbela ukubika nokukhokhwa kwezinsizakalo ezingafanele zikhokhiswe ekumangalisweni ndawonye. Ukuhlela kwe-NCCI kungatholakala kumatafula amane anikezwe kwiwebsite ye-CMS.
Lezi zibhebhe zibhekisela kwezibhedlela kanye nodokotela ukuze babone amasethi amakhodi angenakuthunyelwa ngesimangalo esifanayo noma ahlangane ngokuhlanganyela. Uma isimangalo sinamakhodi womabili, kunezinto ezimbili ezingenzeka:
- Ngokusekelwe ukuthi ikhodi ihlelwe kukholomu 1 noma ikholomu 2 etafuleni, ikhodi yesibili ikholomu izophika. Isibonelo: Umhlinzeki akufanele abike ukuxilongwa okungaxhunyiwe kokunye kokuhlolwa kokutholwa komzimba nge-macmatic diagnostic mammogram. I-mammogram engaxhunyiwe ekuhlanganyeleni ngeke ikwazi ukukhokha.
- Uma ithebula libonisa ukuthi kukhona ishintsho esifanele emitholampilo futhi isilungisi sisetshenzisiwe, kokubili amakholomu azofaneleka. Isibonelo: Sebenzisa i-Modifier 59 ngenqubo yesibili, eyengeziwe noma encane njengoba kubhalwe kukholomu 1 noma ikholomu 2 uma kufanelekile.
I-NCCI: Ukuguqulwa Kwemithi Kungenakwenzeka
I-NCCI ukuguqulwa kwemithi okungenakwenzeka (ama-MUE) nayo isebenza kumakhodi we-CPT ne-HCPCS.
Ngenkathi ukuhlelwa kwenqubo-kuya-inqubo kuvimbela ukukhokhwa kwezinqubo ezingafanele zibikwe ndawonye ngesimangalo sezokwelapha, ama-MUE avimbela ukukhokha kwenombolo engalungile yamayunithi ngenqubo eyodwa.
Izinqubo ezithile zinenani eliphezulu lamayunithi okufanele abikwe ngesiguli esifanayo seMedare (umzuzi) ngosuku olufanayo lwenkonzo ngumhlinzeki ofanayo. Isibonelo, ikhodi yokubhuka kufanele ibikwe kanye kuphela ngesimangalo ngasinye noma iyophika.
Kodwa-ke, kuyilapho odokotela nezibhedlela bekhuthazwa ukuba babike kuphela inani eliphezulu elivunyelwe lamayunithi amakhodi we-CPT ne-HCPCS, kumele futhi alandele imihlahlandlela yokuthobela.
- Gwema izinqubo zokuqeda. Ezinye izinsizakalo zibhekwa njengezozonke. Ukukhipha ukukhokhisa ukukhokhisa ngezinqubo ezihlukene ngokweqile ezikhokhiswa njengekhokhwa elilodwa. Isibonelo, izikhwama zomhlinzeki zezimpawu ezimbili zokuhlola okungahambisani nendawo, esikhundleni sokukhokhisa ukuhlolisisa okuphakathi kokubili kwezwe.
- Gwema izinqubo zokuvuselela. Ukungahlehlisi izinga lensizakalo noma inqubo eyenziwe ukuze ukhokhise ngaphezulu noma uthole izinga eliphezulu lokubuyiselwa kubhekwe ukukhishwa kwekhodi. Ukukhishwa kwe-upcoding kwenzeka nangabe isevisi eyenziwe ayihlanganiswa yi-Medicare kodwa izikweletu zomhlinzeki zihlinzeke ngenkonzo ehlanganisiwe endaweni yayo.
I-NCCI: Ukuhlelwa kwekhodi ye-Add-On
Ikhodi ye-NCCI yokwengeza ivikela ukukhokhwa kwamakhodi wokungezwa okubhekwa njengengxenye yamakhodi we-CPT nama-HCPCS.
Amakhodi angeziwe afakwe kwinqubo eyinhloko awabikwa ngokwehlukana ngakho-ke awafanelekile ukukhokha. Kodwa-ke, kunezinye amakhodi angeziwe afakazela inqubo eyinhloko evumelekile ukukhokha.
Umqulu we-CPT ubonisa futhi unemilayezo eqondile yamakhodi amaningi wokufaka. Ngezinqubo ezinamakhodi aphambili, ikhodi yokwengeza akufanele ibikwe njengekhodi yokufakazela.