Imithetho eyisisekelo yokuCoding Medical

Izikhombisi-ndlela ze-Medical Coder Okudingeka Uzazi

Ukwenza ikhodi yezokwelapha kusiza inqubo yokukhokha ngokuletha ukufaniswa ngezinqubo ngokusebenzisa amakhodi aqaphelayo. Ukusebenzisa amakhodi okuxilongwa okujwayelekile nezinqubo zamakhodi ezibonwa yizinkampani zomshuwalense , yonke imikhuba yezokwelapha, kanye nama-ejensi ahlobene nokunakekelwa okufanele, i-coder yezokwelapha izoqinisekisa ukuthi izinkampani zomshuwalense, umkhokhisi wezentengiselwano, noma amaCenter for Medicare kanye neMedicaid (CMS) izobona into ekhokhisiwe nokuthi ukuxilongwa kuqinisekisa kanjani inqubo, ukuhlolwa, noma ukwelashwa.

Ngenkathi kunezinhlobo eziningi ezihlukene zokukhokhwa kwekhodi ngokusekelwe ekukhethekile kwendlela yokwelashwa, kunezinqubo ezithile eziyisisekelo zokukhokhwa okuzohlala zikhona.

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Ikhodi kuphela Okubhaliwe

Umsebenzi wesidakamizwa ukuloba irekhodi yezokwelapha ngezincazelo eziqondile kuzo zonke izinsizakalo, izivivinyo kanye nezinqubo ezenzelwe kahle futhi zilandele ngokwanele izimpawu zeziguli, izikhalazo, izimo, izifo nokulimala. Njengombhalo wezokwelapha, kubalulekile ukuthi amakhodi alotshiwe ekufuneni kwezokwelapha ahambisana namadokhumenti ngaphakathi kwirekhodi lezokwelapha.

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Bika Amakhodi Ngomyalelo Olungile

Akukona kuphela ukuthi ukubhalwa kwezibalo kanye nezinqubo ngendlela efanele ngokubalulekile kubalulekile, ukuyikhokha ngokulandelana kahle kubalulekile. Ikhodi yokuqala yokuqala isisusa esiqondile sokuvakashelwa kwesiguli ngisho nalapho kutholakala ezinye izifo noma izimpawu noma ngisho nalapho kwenziwa izinqubo eziningi.

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Landela izinkombandlela ze-NCCI ne-MUE

I-Medicare ne-Medicaid banezinselelo ezincane ngokuphathelene nemithetho yokubhalisa kunezinye izinkokhelo zomshuwalense. Ama-Coders kumele abike amayunithi wenkonzo asekelwe ku-National Correct Coding Initiative (NCCI) kanye nokuhlelwa Kokungabonakali Kwemithi (AMUE). Lokhu kwenziwa ukuvimbela ukubika amasevisi amaningi noma izinqubo ezingafanele zikhokhiswe ndawonye ngoba insizakalo eyodwa noma inqubo kungenzeka ukuthi ihlanganisa enye noma ngoba kungenakwenzeka ukuthi iziguli zenzeke ngesiguli esifanayo ngosuku olufanayo.

I-National Correct Initiative Initiative (NCCI) yasungulwa yi-Centers of Medicare neMedicaid Services (CMS) ukuvimbela izinkokhelo ezingafanele zeMedare and Medicaid ngenxa yamaphutha okubhala. Kunezinhlobo ezintathu ze-NCCI ezihlelayo:

1. Ukuhlelwa kwenqubo-kuya-inqubo : Lokhu kuhlela kuchaza amakhodi we-HCPCS nama-CPT angafanele akhokhiswe ngokubambisana omunye nomunye. Uma lezi zimakhodi zikhokhiswa ndawonye eyodwa noma zombili zinganqatshelwa.
2. Ukuhlelwa kwemithi okungenakwenzeka : Lokhu kuhlela kuchaza amakhodi we-HCPCS namakhodi we-CPT ngenani elithile lamayunithi angahle akhokhiswe uma isimangalo silungile. Kwezinye izimo, izinyunithi zesevisi zizonqatshwa ukuthi zidlule lokho okubhekwa ukuthi kuyadingeka ngokwemithi.
3. Ukwengezwa kwekhodi ikhodi : Lokhu kuhlela kuvimbela ukukhokhwa kwamakhodi wokungezwa okubhekwa njengengxenye yamakhodi aphambili we-CPT ne-HCPCS.

Okuningi

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Hlala Usuku Lokuya Kukhokhwa Kwezinguquko

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.

Ukukhokhwa kwe-coding ngokunembile kwenza umkhokheli womshuwalense wazi izimpawu, ukugula, noma ukulimala kwesiguli kanye nendlela yokwelapha eyenziwa udokotela.

Amaphutha ekhodi yokukhokha ayenzeka uma isimangalo sithunyelwa kwinkampani yomshuwalense ngesifo sokuxilongwa okungalungile noma ikhodi yenqubo esimangalo. Ukukhokhwa okungalungile kungaholela emiphumeleni eminingi emibi. Kuyadingeka ukuthi ihhovisi lezokwelapha lihlakulele isimiso sokuhambisana nokuvimbela ukwephulwa kwezidingo zekhodi yezokwelapha.

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Sebenzisa abaguqulwa abafanelekile

Amanye amakhodi we-CPT ne-HCPCS adinga ukusetshenziswa kwe-modifiers. Zinezinombolo ezimbili zamadijithi, izinhlamvu ezimbili noma izinhlamvu ze-alphanumeric. I-CPT ne-HCPCS ikhodi yokuguqula ikhodi inikeza ulwazi olwengeziwe mayelana nensizakalo noma inqubo eyenziwe.

Ngezinye izikhathi ama-modifiers asetshenziselwa ukukhomba indawo yomzimba lapho kwenziwa khona inqubo, izinqubo eziningi esimisweni esifanayo, noma ukhombise inqubo eqalisiwe kodwa ishiyiwe. Abaguqulwayo abashintshi incazelo yenqubo yamakhodi ayengeziwe kuwo.

Amaphuzu okuhlela okuyinhloko:

• Akuwona wonke ama-modifiers angasetshenziswa nawo wonke amakhodi we-CPT ne-HCPCS
• Bheka i-National Correct Coding Initiative (NCCI) ye-Medicare ne-Medicaid encoding
• Yazi kahle ama-modifiers asetshenziswe ngokweqile noma asetshenziswe ngokungalungile
• Ikhodi engalungile yenqubo yenqubo yokuguqula ingabangela ukubambezeleka noma ukuncishiswa kokukhokha

Okuningi