Qaphela lokhu kusetshenziselwa ukukhohlakala nokuzikhandla
Ukwenyuka kwe-upcoding ukukhokhiswa kwezokwelapha okukhohlisayo okusibiza sonke imali futhi kungenzeka impilo. Libhekisela kumkhuba lapho umhlinzeki ekhokhisa umkhokhisi womshuwalense wezempilo (kungakhathaliseki ukuthi uyimfihlo, i- Medicaid noma i-Medicare ) usebenzisa ikhodi ye- CPT yenkonzo ebiza kakhulu kunokwenziwa.
Ukukhishwa kwe-upcoding akuvumelekile. Kungumkhuba wokukhwabanisa osetshenziswa abahlinzeki abazama ukukopela uhlelo ukuze bahokhwe imali engaphezu kokuxoxisana nalabo abakhokha.
Kuyabiza kakhulu iziguli ngabanye kanye nabakhokhi bentela.
Ngaphezu kwalokho, ukukhishwa kwekhompyutha kungaba nemiphumela emibi yezempilo ezigulini. Ibeka imininingwane engamanga emarekhodi abo asezokwelapha futhi ingathinta ikhono labo elizayo lokuthola umshwalense.
Ukukhishwa okusha ngokugcwele
Inqubo ngayinye eyenziwa udokotela noma omunye umhlinzeki wezempilo unakho ikhodi ehambisana nayo evumela ukuba bakhokhele umshwalense wakho, i-Medicaid noma i-Medicare, noma noma ubani okhokhayo-okungenzeka abe nguwe, isiguli. Leyo khodi ibizwa ngokuthi ikhodi ye-CPT, emele i-Current Procedural Terminology.
Uma udokotela wakho ethumela ikhodi kumkhokheli wakho, leyo khodi ye-CPT inquma ukuthi uzokhokhwa kangakanani. Amakhodi ahlukene ahambisana nezinqubo ezahlukene noma amasevisi futhi angaba nezindleko eziphakeme noma eziphansi. Uma nje umhlinzeki esebenzisa ikhodi efanele, umhlinzeki ukhokhwa ngokusekelwe ezinsizeni nezinqubo ezenziwe.
Uma umhlinzeki ephakamisa, noma kunjalo, babela ikhodi yezinsizakalo noma izinqubo ezibizayo kunalokho okwenziwe.
Izibonelo zokuVumelanisa
- Isibonelo sokuqala: Uvakashela udokotela wakho ukuze uhlole ngokushesha. Ikhodi yalokhu kuhambela ikhombisa ukuthi uzokhokhwa u-$ 50. Kodwa, uma udokotela enikezela ikhodi ye-CPT yesheke esandisiwe, uzokhokhwa u-$ 100.
- Isibonelo sesibili: UDkt Cheater uhlola uNksz Smith ngomlenze ophukile. U-Mrs. Smith "ukuphuka" kuphela ukuphuka kwezinwele. UDkt Cheater umtshela ukuba aqaphele futhi asebenzise amathinki ukuze ahlale emlenzeni wakhe amasonto ambalwa.
Kodwa-ke, lapho uDkt Cheater ethumela umtsetfosivivinywa ku-Medicare ngomlenze kaMnuz Smith ophukile, ungena ekhompyutheni ye-CPT ebonisa ukuthi ubeka umlenze wakhe enkundleni, futhi kamuva uhambisa umthethosivivinywa wokususa lezo zinsizakalo zombili ezikhokha ngaphezulu kunalokho akwenza ngempela ukunakekela uNksz Smith, usebenzisa amakhodi ahlukene ukuze akhokhele umshuwalense wakhe kulawo masevisi.
Ukwenyuka kwe-Upcoding kungaba nemiphumela emibi empilweni yakho
Ukwehlisa i-computer kungaba nemiphumela emibi ekunakekeleni kwakho esikhathini esizayo kanye nekhono lakho elizayo lokuthola umshuwalense wezempilo, kuye ngokuthi ikhodi udokotela ayisebenzisa.
Isibonelo, ake sithi unayo into ezwa njengezinhliziyo zenhliziyo. Udokotela wakho angasebenzisa i-EKG futhi athole ukuthi awunayo inkinga ngenhliziyo yakho. Uhamba, ukhululiwe. Kodwa-ke, izikweletu zakho zezokwelapha ze-EKG, kodwa futhi zikhombise ukuvakashelwa kwakho njenge-aphoyintimenti yesiguli senhliziyo, okuletha imali eyengeziwe. Manje amarekhodi akho ezokwelapha akhombisa ukuthi ungase ube nenkinga ngenhliziyo yakho-okuyinto engekho.
Izindlela zokwelapha zakho zesikhathi esizayo zingase zithinteke ngoba irekhodi lakho libonisa ukuthi ungumuntu onenkinga yenhliziyo. Omunye udokotela angase anikeze izidakamizwa ngokuhlukile, noma uma ubonakala ku- ER , bangakuphatha ngokuhlukile. Ngeke uthole ukwelashwa okufanele ngoba amarekhodi akho ayiphutha.
Ngaphezu kwalokho, uthi ulahlekelwe umsebenzi wakho wamanje futhi uzithola uzodinga ukuthola umshuwalense wezempilo kamuva. Okwamanje awukwazi ukuguqulwa ukuze ube nesimo esandulele esikhona ngaphansi kwe- Care Affordable Act , kodwa umshuwalense wakho manje ungakubiza kakhulu kunalokho okufanele.
Kubalulekile ukuthi iziguli zilawule amarekhodi ethu wezokwelapha ngokuhlola kabili amaphutha.
Ukukhishwa kwe-Upcoding akuvumelekile futhi kuyasibiza imali
Ukukhishwa kwe-upcoding akukho emthethweni nokukhohlisa . Noma yimuphi umhlinzeki ophakamisa ngamabomu uphula umthetho.
Njengeziguli, singase sicabange ukuthi asinandaba nathi ngoba ungumshwalense owukhokhela. Kodwa-ke, ukukhishwa kwesikweletu kubiza sonke thina imali, kokubili njengabakhokhi bentela futhi njengabakhokhisi be-premium.
Uma isiguli seMedare noma iMedicaid sihlehlisiwe, izindleko zalezi zinhlelo zomphakathi ziyanda futhi sonke siyikhokhela ngezintela.
Uma umshuwalense wangasese ethola imali ekhokhwayo, ama-premium aphakanyiselwe wonke umuntu onomshuwalense . Omunye umhlinzeki we-upcoding angasilahlela zonke izigidi zamaRandi ngokuhamba kwesikhathi.
Okufanele Ukwenze Uma Usola Ukukhuphuka
Uma uhlola Ukulinganisa Kwezinzuzo zakho (EOB) futhi ukholwa ukuthi udokotela wakho unecala lokukhishwa kwekhompyutha, kunezinyathelo ezithile ongazithatha ukuze uqinisekise ukuthi ukhokha wakho akakhokhiwe ngobuqili.
- Okokuqala, xhumana nomhlinzeki wakho bese ubuza ngakho. Bangakwazi ukukuchazela ukuthi kungani kulungile, noma banganikela ukuyilungisa. Kunoma yikuphi, kuzokufakazela ukuthi udinga ukuqhubeka uhlola i-EOB yakho isikhathi ngasinye lapho kufika khona.
- Uma ungenelisekile ngempendulo, futhi noma ngabe bayanikeza ukuyilungisa, uzofuna ukuhlola ama-EOB adlule ukuze ubone ukuthi ungakwazi yini ukukhomba umkhuba ekukhuliseni i-upcoding.
- Uma usola ukuthi umhlinzeki wakho uhlaziya ngokujwayelekile, uzofuna ukuyibika kumkhokhi wakho ngokushesha. Uma lowo mhlinzeki evuselele ukunakekelwa kwakho izikhathi ezingaphezu kwesisodwa, khona-ke uyenzele nabanye, futhi.
Uma umkhokheli wakho ungumshwalense wangasese, shayela ucingo lwabantu bamakhasimende futhi ubuze ukuthi ubani okufanele ubike ukukhwabanisa ukukhishwa kwesikweletu.
Uma uthola i-Medicaid, kuzodingeka uhlole ihhovisi le-Medicaid lombuso ukuze ubone ukuthi bafuna ukukhishwa kwesikrini noma ukukhwabanisa okunye.
Uma ukhokha wakho yi-Medicare, uzothola izinyathelo zokubika ukukhwabanisa, kufaka phakathi ukukhishwa kwe-khompiyutha, kuwebhusayithi ye-Medicare.