Iziphambeko ezimbili zokuCoding zezokwelapha Kufanele Ugweme
Ukweqa ngokweqile nokukhokha ngaphansi kwamakholi kunamaphutha amabili ekhodikhodi angaba nemiphumela emibi ehhovisi lezokwelapha. Ukudayiswa kwezokwelapha akukhona nje ngokuthola ukubuyiselwa kwemisebenzi enikeziwe. Ukukhokhwa kwe-coding ngokucacile kwenza umkhokheli womshuwalense wazi ukugula noma ukulimala kwesiguli kanye nendlela yokwelapha.
Kukhona nezinye izinsiza zokwenza ikhodi yezokwelapha:
Ukubhala noma ukubika ikhwalithi yokunakekelwa kwesiguli.
Ukuhlinzeka ngokuxhumana okunembile ngokusebenzisa uhlelo lokuhlukaniswa kazwelonke oluqondakala kubo bonke abakhokha nabahlinzeki.
Ukubika idatha esetshenziselwa izifundo ezihlukahlukene zocwaningo ezifana nezifo, izidakamizwa, izinqubo noma izitayela zokunakekelwa kwezempilo.
Ukwenza izinqumo ezibalulekile zokuphatha njengezokumaketha, ukubambisana, ukuhlelwa kwesabelomali nokuthenga
Ukweqa ngokweqile kuwukukhwabanisa
Ukunqunyelwa kwamakhodi we-CPT ne-HCPCS kuyindlela yokwenza ikhodi ngenhloso yokubika amakhodi ngendlela eholela ekukhokheni okuphakeme. Ukweqa ngokweqile kuwubuhlungu obukhulu.
Ukweqa ngokweqile kuholela ezinkampanini zomshuwalense ezenza imali ephindwe kakhulu kunalokho okumele kube khona ukubuyiselwa kwangempela. Kodwa-ke, izinhlawulo zokubanjwa zidlula kakhulu izinzuzo zokuthola ikhokheji ephakeme.
Kunezindlela ezimbili ezijwayelekile abahlinzeki abakhiphayo, bayakhokhisa futhi bahlaziya.
- Ukwenyuka kwe-upcoding : Ukungahlehlisi izinga lezinsizakalo noma inqubo eyenziwe ukuze ukhokhise ngaphezulu noma uthole izinga eliphezulu lokubuyiselwa kubhekwe ukucutshungulwa. Ukukhishwa kwe-upcoding kwenzeka nangabe isevisi eyenziwe ayihlanganiswa yi-Medicare, kodwa izikweletu zomhlinzeki zihlinzeka ngemisebenzi ehlanganisiwe endaweni yayo.
- Ukukhipha : Ezinye izinkonzo zibhekwa njengezozonke . Ukukhipha ukukhokhisa ukukhokhisa ngezinqubo ezihlukene ngokweqile ezikhokhiswa njengekhokhwa elilodwa. Isibonelo, izikhwama zomhlinzeki zamakhompiyutha amabili wokuhlola okungafani, esikhundleni sokukhokhisa ukuhlolwa kwesinye sezwe esisodwa.
Khumbula ukuthi ukunqotshwa kwe-overcoding ukukhwabanisa, futhi imiphumela ingabangela izinhlawulo zomthetho nezomnotho.
Kudingeka liqashwe ngokumelene nokwenza iphutha, ngokubukeza nokufundiswa okuqhubekayo.
Ukunciphisa i-Lost Revenue
Ukufakwa ngaphansi kwe-CPT ne-HCPCS amakhodi lapho amakhodi akhokhiswa engabonisi ukugcwele okuphelele komsebenzi okwenziwa udokotela noma indawo. Ukufakwa ngaphansi kwe-undercoding kungaholela ekulahlekelweni kwezimali.
Abanye abahlinzeki ngenhloso bazitholela ukuvimbela ngokwabo ekuhlolisweni kwezinkampani zomshuwalense ezingase ziphike noma zihlole izimangalo. Lokhu kucabanga kungabangela izinkinga eziningi ngesizathu esisodwa: akulona iqiniso. Izinkampani zomshuwalense aziphiki ngoba amakhodi abuyisa phezulu kunamanye amakhodi. Izinkampani zomshuwalense zifuna amakhodi ukufanisa imibhalo erekhodi lesiguli.
Indlela yokugwema ukuphika ukuqinisekisa ukuthi imibhalo efanele. Imibhalo ayihlanganisi kuphela izimpawu, ukuxilongwa, ukunakekelwa, ukwelashwa, kanye nemithi kodwa futhi nezinkinga nezingozi zokuthola ulwazi lwezempilo nokuphepha. Irekhodi lesiguli kumele libe neningiliziwe futhi liphelele.
Ukuze uvimbele kokubili ukukhishwa kwe-encoding ne-undercoding, ihhovisi lezokwelapha kufanele lihlale lihambisana noshintsho lwamakhodi wonyaka. Kufanele uqiniseke ukuthi ulandela imihlahlandlela ejwayelekile yokubhala futhi uqinisekise ukuthi abasebenzi bakho bathola imfundo eqhubekayo. Ukugcina amarekhodi okugcina okugculisayo ngumsebenzi wabahlinzeki kanye nabasebenzi bokusekela.