Imithwalo yemfanelo yokuPhathwa kolwazi lwezeMpilo

Ukuqinisekisa Ukunemba, Ukufinyeleleka, kanye Nobumfihlo beLwazi LwezeMpilo

Ukwaziswa kwezempilo kwezempilo kuyinkqubo yokugcina, yokugcina nokuthola ulwazi lwezempilo ngesineke ngokuhambisana nezidingo zikahulumeni, uHulumeni, nezidingo ezigunyaziwe. Kunemithwalo yemithwalo eyisisekelo eyishumi ngaphakathi kohlaka lokuphathwa kolwazi lwezempilo (HIM) oludinga ulwazi olukhethekile, amakhono namakhono. Nansi isifinyeto esifushane sale mithwalo yemithwalo eyishumi.

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I-Basics of Coding Medical

Ukwenza ikhodi yezokwelapha kubandakanya isabelo esifanele samakhodi wezokwelapha ukubuyisela okufanelekayo ngabashuwalense nabakhokha njengama-Medicare ne-Medicaid. Kusho nokuqinisekisa ukuthi wonke amarekhodi ezempilo afaka ukuxilongwa okufanele ngokuya kwenqubo elandelwe. Kukhona amasethi amakhodi amaningana amakhodi asetshenziswayo, futhi kumele abe nezinsiza ezisesikhathini samanje njengoba amanye amakhodi ashintsha njalo ngonyaka.

• Amakhodi we-ICD-9
• Amakhodi we-CPT
• Amakhodi we-HCPCS
• I-DRG (Ukuxilongwa Amaqembu Ahlobene)
• Izinguquko

Okuningi

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Ukunyatheliswa Kwezokwelapha

Ukubhalwa kwezokwelapha kubhekisela ekubhalisweni okunembile nokufika kwesikhashana kolwazi lwezempilo olubhekene nesiguli ukuze lufinyeleleke kumaqembu agunyaziwe:

• Umlando wezokwelapha ogulayo
• Imibiko yomzimba enesineke
• Imibiko yokubonisana nodokotela
• Izifinyezo zokukhipha iziguli
• Imibiko ye-Radiology
• Imibiko yokusebenza

Okuningi

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Ukwelashwa Okudingekayo

Isidingo sezokwelapha sibhekisela ekwelapheni okunengqondo futhi okudingekile, izinqubo noma amasevisi okugula. Abaningi bomshuwalense, kuhlanganise ne-Medicare ne-Medicaid, ngeke bakhokhele ukwelashwa okungacatshangwa ukuthi kuyadingeka ngokwemithi ngokusekelwe ezindinganisweni zokunakekelwa.

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Ukusekelwa kwabasebenzi bezokwelapha

Ingxenye enkulu yokuphathwa kolwazi lwezempilo inikeza ulwazi odokotela mayelana neziguli eziphathwayo njengoba ziceliwe. Kuhlanganisa nokubukeza amarekhodi okuhambisana nomhlahlandlela womshuwalense wombuso, wesifundazwe nongasese. Ngemuva kokubuyekezwa, noma yikuphi ubuthakathaka bokuhambisana kufanele kuhanjiswe kudokotela nakwezinye izidokotela ukuba bavumele ukuthuthukisa amaphepha abo.

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Iqoqo Lamarekhodi Ezokwelapha

Irekhodi ngalinye lezokwelapha kufanele lihlangane ukuze lisetshenziswe ekuqhubekeni kokunakekelwa kwezempilo ngokunikeza:

• Irekhodi elinembile, lomthetho
• Ukubhaliselwa kwemibiko yezokwelapha
• Ukuhanjiswa kolwazi lokubuyisela
• Ukufinyeleleka ezinhlanganweni ezigunyaziwe ezicela ulwazi

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Ukugcinwa kwamarekhodi wezokwelapha

Ukugcina amarekhodi wezokwelapha iziguli kufaka hlangana ukuqiniseka nokutholakala kwamarekhodi wokuragela phambili kokunakekelwa ngesikhatsi sokuphila kwesiguli. Lokhu kufaka phakathi kokubili iphepha kanye namarekhodi wezokwelapha.

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Ukufakiwe

Ukufakwa kwamarekhodi ezempilo kuhlanganisa ukuklama nokuthuthukisa isakhiwo sohlelo lwezokuphathwa kolwazi okuwukuthi

• kalula
• ihlelwe
• ivikela imfihlo yesiguli
• ngokuhambisana nemithetho kanye nemihlahlandlela ye-HIPAA

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Ubumfihlo nokuphepha

Ngokusetshenziswa kokwandiswa kobuchwepheshe bezokwelapha ekunakekelweni kwezempilo, ihhovisi lakho lezokwelapha kumele liqhubeke nokuthola izindlela zokulondoloza ubumfihlo nokuvikeleka kolwazi lwezempilo oluvikelwe (i-PHI) yeziguli abakhonza ngazo.

• Ukugcinwa kolwazi lwezempilo oluvikelwe ngendlela evimbela ukugcina kweziguli
• Qalisa izici eziqinisekisa ukuthi abasebenzi behhovisi lezokwelapha banokuqeqeshwa okufanele nokugunyazwa ukufinyelela ku-PHI
• Sebenzisa izilawuli zokubethela ukuvikela idatha edluliselwe phezu kwenethiwekhi

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Ukukhishwa kolwazi

Ukwaziswa kwesineke kungacelwa ngezizathu eziningi ezifana nezinhloso zomshuwalense noma ukuqhubeka kokunakekelwa. Ihhovisi lezokwelapha linomthwalo wemfanelo wokukhulula ulwazi ngesikhathi esifanele ngokugunyazwa okufanele kwesiguli noma ummeleli ogunyaziwe. Ukukhishwa kwezinsizakalo zolwazi kufaka:

• Ukuthola imvume evumelekile yokukhululwa kolwazi lwezempilo oluvikelwe
• Ukugcwalisa irekhodi lezokwelapha lokukopisha
• Ukudluliswa kwerekhodi yezempilo kagesi
• Izicelo zokulandelela nokuqapha isikhathi sokuphendula

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Ukugcina ukufihla

Bonke abahlinzeki bezempilo banomthwalo wemfanelo wokugcina abasebenzi babo baqeqeshwe futhi banolwazi mayelana nokugcinwa kwemfihlo yesiguli. Ukuqashwa kwabasebenzi ukuvikela ulwazi lwesiguli kumele kufakwe

• Ukulahlwa okufanele
• Isitoreji esifanele
• Ukufinyelela okulungile
• Ukudalulwa okulungile