I-Medicare Yandisa Ukusetshenziswa koMthethosivivinywa Uhlobo lwe-14X
I-Medicare yandise ukusetshenziswa kwe- bill bill 14X ekuqaleni kuka-2014. Ngaphambi kokuguqulwa, uhlobo lwe-bill 14X lwalusetshenziselwa isikhalazo esibhedlela esibhedlela esibhedlela esingenaso isiguli. Lokho kwakusho kuphela ukuthi ucwaningo luya ebhodini, isiguli asihambanga esibhedlela ngomuntu. Ukulandela ushintsho, isiguli singenza noma singabonakali esibhedlela.
Ukusebenzisa nini uBill Bill 14X
- Uma isiguli sinikeza esibhedlela futhi sithola kuphela amasevisi e-laboratory, izinsizakalo zingakhokhiswa ngohlobo lwe-bill 14X.
- Uma isiguli sinikeza esibhedlela futhi sithola kokubili izinsizakalo ze-laboratory kanye neziguli ezihlinzekwe iziguli ngodokotela ohlukile ngandlela ngayinye, izinsizakalo ze-laboratory zingahlawuliswa ngohlobo lwe-Bill 14X kanye nezinsizakalo zezokwelapha zingakhokhiswa ngohlobo lwe-bill 13X.
Kungani Kutjhuguluka?
Ngokusho kwe-CMS.gov, izibhedlela zakwa-Outpatient Prospective Payment System (OPPS) zikhokhelwa izivivinyo zelabhorethri ezenziwa esilungiselelweni sesipiliyoni ku-Clinical Laboratory Fee Schedule (CLFS). Njengoba ukuhlolwa kwe-laboratory kukhokhwa ku-CLFS, ukuze uvumele ukukhokha okuhlukile nokukhokha kuma-CLFS, ama-CMS akwandisa uhlobo lwe-Bill 14X.
Lokhu kusho ukuthini kwabanikezeli?
Ukwandiswa kohlobo lwe-bill 14X kusho ukuthi izibhedlela ezikhokhelwa izinsizakalo ze-laboratory zinga:
- Sebenzisa uhlobo lwe-bill 14X ukuze uthole imali yezinsiza eziningi ze-laboratory
- Qhubeka ukusebenzisa uhlobo lwe-bill 13X yezivivinyo ze-molecular pathology. Izivivinyo ze-molecular pathology zihlanganisa amakhodi we-CPT 81200 kuya ku-81383, 81400 kuya ku-81408, no-81479.
- Qhubeka ukusebenzisa uhlobo lwe-bill 13X yezinsizakalo ze-laboratory nezinye izinsizakalo eziphuthumayo ezilethwe udokotela ofanayo ngosuku olufanayo
- Sebenzisa uhlobo lwe-bill 14X ku-bill yezinsizakalo ze-laboratory kanye nohlobo lwe-bill 13X ku-bill ukuze uthole ezinye izinsizakalo zeziguli lapho izinsizakalo ziyalwa odokotela abahlukile ngosuku olufanayo.
Izikhumbuzo Zezinkokhelo Zama-Medicare
- Ikhodi idinga ngokufanele kusekelwe ezinsizeni, ukuhlolwa kanye nezinqubo ezenziwe
- Bika amakhodi wenqubo ye-CPT / HCPCS ku-Medicare ehambisana kakhulu namadokhumenti kumrekhodi wezokwelapha
- Khetha futhi ubike amakhophi afanelekile kumakhodi we-CPT / HCPCS esimangalo ngokusho kwemikhombandlela ye-Medicare
- Izimangalo zefayela zingakapheli unyaka owodwa ngosuku lwenkonzo ye-Medicare eyinhloko kanye nezimangalo ze-MSP
- Bika izinyunithi zesevisi ezisuselwe ku-National Correct Initiative (NCCI) kanye nokuhlelwa okungahle kwenzeke ngemithi (AMUEs) ukuvimbela ukubika izinsizakalo eziningi noma izinqubo ezingafanele zikhokhiswe ndawonye ngoba inkonzo eyodwa noma inqubo kungenzeka ukuthi ihlanganisa enye noma ngoba kungenakwenzeka ukuthi kwenziwa ngesiguli esifanayo ngosuku olufanayo
- Yenza isaziso se-Advance Beneficiary Notice (ABN) efonini ukuze ubhale ngokucophelela izinsizakalo ezingabonakali ne-modifier efanele, okungukuthi i-GA noma i-GZ, ezokhomba izinsizakalo ezingakhokhiswa noma zingakhokhiswa isiguli.
Iyini i-OPPS?
Isistimu Yokuphulukisa Isibhedlele Esiphuthumayo, noma i-OPPS, ikhokha for:
- izinsizakalo ezithile zezempilo ezibhedlela
- ezinye izinsizakalo ezibhedlela ezihlinzekwa yi-Medicare Part B yeziguli ezingenayo i-Medicare Part A
- izinsizakalo zokuhlala esibhedlela
- ukuphathwa nokugonywa kwe-Hepatitis B, ama-splints, ama-antigens nama-antigens yi-ejensi yezempilo yasekhaya ezigulini ezingekho ngaphansi kwepulani lezempilo lwe-ejensi yezempilo noma iziguli ezingelapheki
Isistimu yokuPhelelwa kokuPhelelwa kweZibhedlela, noma i-OPPS, ayikhokheli:
- izinsizakalo zezokwelapha zezokwelapha
- izinsizakalo zokwelashwa eziphuthumayo
- ukuhlolwa nokuhlolwa kwe-mammography
Kuyini i-CLFS?
I-Schedule Clinical Fee Schedule, noma i-CLFS, ikhokhela izinsizakalo zezokwelapha ezihlinzekwa esibhedlela ngenxa yesimiso semali. Izinsizakalo ezikhokhelwa ngaphansi kwe-CLFS azikho ngaphansi kwamakhophi we-copay kanye nama-deductibles.
Izinguquko ezengeziwe ezenziwe ngo-2014
Imboni yezempilo kanye nezokwelapha ishintsha njalo. Kungumsebenzi wehhovisi lezokwelapha ukuhlola, ukuhlaziya nokusebenzisa izinguquko ezinhle ukuvikela intshisekelo yonke inhlangano.