Ukubuyiswa komshuwalense kuxhomeke ekuchithweni kwekhodi yezokwelapha
Ukwenza ikhodi yezokwelapha kuyisici esiyinhloko ekutholeni ukubuyiselwa kweminshuwalense kanye nokugcina amarekhodi eziguli. Ukukhokhwa kwe-coding ngokucacile kwenza umkhokheli womshuwalense wazi ukugula noma ukulimala kwesiguli kanye nendlela yokwelapha.
Ukugwetshwa kwezicelo zezokwelapha yinkqubo esetshenziswa ngabashuwalense ukuhlola ikhodi bese inquma ukuthi inqubo izobuyiselwa, inqatshelwe noma iyancishiswa.
Uma kukhona iphutha ekukhokheni ikhodi, kungabangela ukuthi isimangalo siphiwe. Ukuxilongwa noma inqubo ekhokhiswayo angeke ihlanganiswe uhlelo lomshuwalense, noma lungase luhlanganiswe kancane, nakuba lugunyaziwe ngaphambili
Ngenxa yalokho, umhlinzeki angase akhokhe ngokugcwele ngensizakalo enikeziwe, noma isiguli singalindelekile ukuthi sibophezele ukukhokhela izinsiza ngaphandle kwephaketheni.
Izingozi zokuqothulwa nokugqwayiza
Kukhona futhi kungaba nemiphumela yezomthetho neyezimali ekukhoneni okungekho emthethweni kwezokwelapha. Ukweqa ngokweqile ukubika amakhodi ngendlela eholela ekukhokheni okuphakeme ngumshwalense. Lokhu kungabhekwa njengokukhwabanisa futhi kuholele ekushushisweni, ngezijeziso zomthetho nezomnotho.
Inkinga ephikisanayo i-undercoding, hhayi ukufaka amakhodi azo zonke izinqubo ezenziwe noma ukubhalisa ngezinqubo ezibuyiselwa ngezinga eliphansi. Lokhu kubangela imali elahlekile yomhlinzeki.
Ulwazi oluyisisekelo kunazo zonke oludingekayo ekumangalisweni kwezinkomba kuyi-ICD (I-International Classification of Diseases) amakhodi amanye aziwa ngokuthi amakhodi okuxilongwa.
Ukuxilongwa kanye Namakhodi Wokusebenza
Amakhodi wokuxilonga asetshenziselwa ukuchaza ukuxilongwa, isibonakaliso, isimo, inkinga noma isikhalazo ezihlobene nokwelashwa kwesiguli.
Ukuhlonza kumele kubhalwe phansi izinga eliphezulu lokuvakashelwa.
Ngokujwayelekile, amakhodi e-ICD asetshenziswa kanye namakhodi we-HCPCS (i-Healthcare Common Procedure Coding System). Amakhodi we-HCPCS achazwa emazingeni amathathu.
- Amakhodi I-CPT (Current Procedural Terminology) amakhodi ayizinombolo ezingu-5 futhi alawulwa yi-American Medical Association (AMA). Amakhodi we-CPT asetshenziselwa ukukhomba izinsizakalo zezokwelapha nezinqubo eziyalwe odokotela noma ezinye izichwepheshe ezilayisensiwe.
- I-Level II i-HCPCS yizinombolo ze-alpha ezinombhalo owodwa we-alfabhethi olandelwa izinombolo ezine futhi ilawulwa yi-The Centers for Medicare neMedicaid Services (CMS). Lezi zimpawu zikhomba amasevisi angewona odokotela njengamasevisi we-ambulensi, imishini yokwelapha ehlala njalo, kanye nekhemisi.
- Amakhodi we-Level III amakhodi alphanumeric W, X, Y, noma Z alandelwe ikhodi yezinombolo ezine. Ngaphandle kwalokho eyaziwa njengamakhodi wendawo, lawa manikhodi asetshenziswa njengekhodi ehlukile uma kungekho iveli ye-I noma yezinga le-II ukulikhomba.
Amakhodi anzima kakhulu yi-DRG's (Ukuxilongwa Amaqembu Ahlobene). I-DRG iyinhlanganisela ye:
- Ukuxilongwa
- Izinqubo
- Izinkinga
- Izimpawu
- Imibandela ekhona ngaphambili
- Ubudala nobulili
I-DRG isetshenziselwa kuphela ukukhokha izimangalo zesiguli. Abaningi bomshuwalense bakhokhela ngokusho kwe-DRG, ngakho-ke, ukunemba kwazo zonke izingxenye kubalulekile ekubuyiseni isimangalo esifanele.
Isimangalo esifanele sincike ezintweni eziningi. Ukuhlala usesikhathini ekushintsheni kwamakhodi waminyaka yonke, ukulandela imihlahlandlela yokubhala ikhodi ejwayelekile futhi ukugcina amarekhodi ezinguli ezitholakala ngokugcwele kuyindlela elula yokuqinisekisa ukuthi izimangalo zezokwelapha zinembile.