Ukuqonda Per Diem, Ngengqikithi, Ukubethelwa, ne-Fee-for-Service
Umshuwalense wezokwelapha ukhokha abahlinzeki ngokusebenzisa izindlela ezine ezahlukene. Ukuqonda izindlela ezahlukene zokukhokha kubalulekile ekuphathweni kwezezimali kwehhovisi lezokwelapha . Lezi kufanele zicatshangelwe lapho kuthuthukisa isu lokuphatha izimali.
- I-Per Diem / Izinkokhelo Zokuvakashelwa
- Ngama-Payments we-Episode
- Izinkokhelo Zokuthunjwa
- Izinkokhelo ze-Fee-for-Service
I-Per Diem kanye Nezindleko Zonke Zokuvakashelwa
Inkokhelo yomshuwalense eyenziwe ehhovisi lezokwelapha usuku ngalunye noma ukuvakashelwa yi-diem ngayinye noma inkokhelo ngayinye yokuvakasha. Izinkokhelo zemihla ngemihla zenziwe ngokusekelwe esilinganisweni esinqunyiwe kungakhathaliseki ukuthi isikhathi esichithwa udokotela sinikeza ukwelashwa noma izinsizakalo ezitholwa yisiguli ngesikhathi sokuvakasha.
Ukuvakashelwa iziguli ezibhedlela nezikhungo zokuhlengikaza abanekhono yizibonelo zezenzakalo ezingase zifanele ukuthola izinkokhelo zokukhokha ngayinye ngokuvumelana nenkontileka umkhokhisi womshuwalense onesikhungo.
Izinkokhelo ezihloswe ngokujwayelekile zikhokhwa emtholampilo, impilo yasemakhaya, ukwelashwa ngokomzimba, noma ukuhlelwa kweziguli.
I-Per-Episode noma Izinkokhelo Zamanani Ezezimali
Izinkokhelo ze-episode zenzelwe zonke izinsizakalo ezenziwa ngesikhathi esisodwa sokunakekelwa. Baphinde babhekiswe njengezilinganiso zamacala. Isiqephu sokunakekelwa singadlulela ezinsukwini ezimbalwa noma ukuvakashelwa futhi kufakwe ukukhokhelwa okulodwa.
Izinkokhelo zesiqephu ngokuvamile zenzelwe ukuvakashelwa kwamagumbi okuphuthumayo, izinqubo zokuhlinzeka ngezigulane, noma ukuvakashelwa kweziguli ezigulisa iziguli. Lapho lisetshenziselwa ukuvakashelwa esibhedlela esibhedlela, ukukhokha kuvame ukusekelwa ngokusekelwe kuma- DRG (Ukuxilongwa Amaqembu Ahlobene).
Ama-DRG anikezwa ukuhlukaniswa ngokusekelwe kuhlanganiswa kwe-ICD-9 yokutholakala kwamakhodi, amakhodi enqubo ye-CPT ne-HCPCS, izinkinga noma izimo ezikhona ekungenisweni, isimo sokukhishwa, iminyaka yobudala kanye nocansi. Izinkokhelo ze-DRG nazo zisekelwe esikhathini esithile, okuyizinombolo ezidingekayo zokwelapha okwanele.
Ukukhokhelwa Patient noma Ukuthunjwa
Izinkokhelo zesiguli, noma izinkokhelo zokuthunjwa, zikhokhwa, izinkokhelo zenyanga zonke ezithola ihhovisi lezokwelapha isiguli. Leli nani lihlala lingalingani kungakhathaliseki ukuthi bangaki ukuvakashela isiguli noma izindleko zezindleko ezithintekile ngisho noma bengakutholi ukunakekelwa nhlobo.
Izinhlelo ze-State Medicaid ziyisibonelo somkhokhi owenza izinkokhelo zesiguli ngasinye. Odokotela bakhokhelwa inani elibekwe isiguli ngasinye seMedicaid banikela ngezinsizakalo kulabo ababhalisile emtholampilo noma ekusebenzeni kwabo. Lena indlela ephumelela kakhulu yokunciphisa izindleko zokunakekelwa kwezempilo ngenkathi kukhuthaza ukunakekelwa kokuvimbela.
Izinkokhelo ze-Fee-for-Service
Indlela ejwayelekile kunazo zonke yokukhokha kuyimodeli yokukhokhela imali. Kukhokhwa-ngensizakalo, ihhovisi lezokwelapha likhokhwa inani elibekiwe lohlobo ngalunye noma iyunithi yesevisi eyenziwe. Ukuvakasha kwehhovisi, ukuhlolwa kwelebhu, i- x-ray noma enye insizakalo iyakhokhwa ngokuvumelana nesimiso semali. Uma ukunakekelwa kwesiguli kunomtholampilo, izinkokhelo ezengeziwe zenziwa.
Le ndlela yokukhokha ivumela ihhovisi lezokwelapha ukuthi lithole ukubuyisela okuphezulu kwesicoco ngasinye sokunakekelwa.
Ukuphathwa Kwezezimali Nezimali Ziyatholakala
Ukuphathwa kwezezimali kungukuphathwa okuphumelelayo nangempumelelo kwemali eyenziwe yinhlangano ehlanganisa zonke izingxenye zomjikelezo wemali kubandakanya ama-akhawunti afanelekayo.
Ama-receivables ama-Akhawunti, awaziwa nangokuthi i-accounting yesiguli, ibhekisela kwimali engenayo eyakhiwe kodwa engakaqoqiwe. Ukuqinisekisa ukugeleza kwemali kukwanele ukuphathwa okusebenzayo, ihhovisi lezokwelapha linomthwalo wokwandisa amathuba okuthola imali.
Ihhovisi lezokwelapha lingathola izinkokhelo zomshuwalense yiziphi noma zonke izindlela ezahlukene. Ukukhetha ukuthi yiziphi izinkampani zomshuwalense ozisebenzisana nazo zinganquma ukuthi iyiphi inkokhelo ekhokhelwa ihhovisi.