Iziphambeko eziphezulu eziyisi-5 zokukhokhela ezempilo

Ukunciphisa Ukwebiwa Kwezimangalo Zezokwelapha Ngokubamba Leziphutha Zokukhokha

Amaphutha okukhokha kungabangela ukuphika okuningi kokumangalelwa kanye nezinkinga zezezimali zehhovisi lezokwelapha. Izinkokhelo ezinqanyelwe, izinhlawulo ezibiza kakhulu, nokulahlekelwa kwemali konke kungenzeka uma amaphutha engabanjwa ngaphambi kwesikhathi. Uma ngabe ihhovisi lakho lezokwelapha libhekene nobunzima bezezimali, kungase kudingeke ukuthi ubuyekeze izimangalo zakho ngamaphutha okukhokha okuvame kakhulu ngaphambi kokukhokha izimangalo zakho.

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Ukuhluleka Ukuqinisekisa Umshwalense

Isizathu esisodwa sokuthi kungani izimangalo eziningi zokukhokhiswa kwezokwelapha zinqatshelwe ngumphumela wokungaqinisekisi ukufakwa komshuwalense. Ngenxa yokuthi ulwazi lomshuwalense lungashintsha nganoma yisiphi isikhathi, ngisho neziguli ezivamile, kubalulekile ukuthi umhlinzeki aqinisekise ukufaneleka kwesilungu njalo kunikezwa izinsizakalo. Kunezinkolelo ezine ezivame ukuhambisana nokuqinisekiswa komshuwalense:

1. Ukuqashwa kwamalungu kunqanyulwe noma akufanelekile kulolu suku lwenkonzo
2. Izinsizakalo ezingagunyaziwe
3. Izinsizakalo ezingahlanganiswa nezinzuzo zepulani
4. Izinzuzo ezinkulu zihlangene

Okuningi

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Ulwazi olungaphelele noma olungaphelele

Ukungalungi okulula emininingwaneni yesiguli kungaholela ekukhokheni ukukhokha. Imininingwane emincane kakhulu ibalulekile ukuze uthole izikweletu zezokwelapha ezikhokhwe okokuqala. Abasebenzi basehhovisi langaphambili bangasiza ekunciphiseni lezi zinkolelo ngokuhlola imininingwane elandelayo yeshadi lesiguli:

• Ingabe igama lesiguli libhalwe kahle?
• Ingabe usuku lwesiguli sokuzalwa nobulili lungalungile?
• Ingabe umkhokhisi womshuwalense oqondile ungene?
• Ingabe inombolo yenqubomgomo ivumelekile?
• Ingabe isimangalo sidinga inombolo yeqembu okufanele ifakwe?
• Ingabe isimo sobuhlobo besiguli siqondile kunama-insured?
• Ingabe ikhodi yokuhlonza ihambisana nenqubo eyenziwe?
• Ingabe ikhodi yenqubo yesevisi eyenziwe ifana nokugunyazwa okutholiwe?
• Ngama-insurances amaningi, ingabe unembile yomshuwalense oyinhloko ekuxhumaneni kwezinzuzo?

Ukwehla ngenxa yezintambo ezingenhla kungabuyekezwa kodwa esikhundleni sokukhokha kwezinsuku ezingu-14 kuphenduka, kungathatha izinsuku ezingu-30 kuya kwezingu-45 ukugcina ikhokhwe.

Okuningi

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Ukuxilongwa okungalungile noma Amakhodi Wokusebenza

Ukukhokhwa kwekhodi ye-coding kuvumela ukuthi umkhokhisi womshuwalense azi 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. Lokhu kungabangela ukuthi isimangalo siphiwe ngenxa yezizathu ezinjengokuthi akukho isidingo sezokwelapha noma inqubo ayihambisani nokugunyazwa.

Ezinye izizathu ezenza ikhodi engafanele yokuxilongwa noma ikhodi yenqubo ingaqeda isimangalo:

• Ukusebenzisa izincwadi ezindala zokubhala. Ama-coding izincwadi kufanele abuyekezwe minyaka yonke ngenxa yezinguquko ekukhokheni ikhodi. Ukufaka esikhundleni sezincwadi zamakhodi kungabiza kodwa akufanelekile ukulahlekelwa yinzuzo ngenxa yokuphika okungadingekile.
• Amaphutha wokubhala ngesandla. Kubonakala sengathi ubuhlungu obudakayo kodwa obumpofu obudokotela buyingxenye yezimbangela ezihamba phambili zokuphoqa ukukhokha unyaka ngamunye. Enye indlela yokuthuthukisa ukunemba ukuguqula isistimu esekelwe ephepheni ukuya kumarekhodi wezempilo kagesi (EHR).

Okuningi

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Ukukhokha noma ukukhokha okungalungile

Ukukhokha okuphindaphindiwe kuyinkokhiso yenqubo efanayo, ukuhlolwa, noma ukwelashwa okungaphezu kwesisodwa. Amaphutha afanayo angaba yikhokhiso yensizakalo engafanele noma ukukhokhiswa kwezinsizakalo ezingakaze zenziwe. Ngezinye izikhathi inqubo noma ukuhlolwa kukhanseliwe kodwa akukaze kususwe ku-akhawunti yesiguli. Esikhathini esiningi, lezi zinhlobo zamaphutha zibangelwa iphutha lomuntu elula. Kodwa-ke, izakhiwo eziningi zikhokhiswa unyaka ngamunye ngenxa yokwenza ubuqili ngenxa yalesi sizathu. Ukukhwabanisa kubhekwa njengokuzithandela nangokwazi ukufaka izimangalo zezokwelapha ezingalungile.

Enye indlela yokugwema ukungalungi ekukhokhweni kwezokwelapha ngukukwenza ukuhlolwa kwezhadi. Ukuhlolwa kwamashadi kuyindlela elula yokuqinisekisa ukuthi zonke izingxenye zesimangalo zikhokhwa ngendlela efanele.

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Ukuhlehlisa noma ukukhipha

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.

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.

Okuningi