Ingabe ukuhlinzwa kwakho kuyokwenza uhlu?
Kunezinto eziningana okudingeka uzicabange ngaphambi kokuhamba ngaphansi kommese. Okokuqala, yiqiniso ukuthi ukuhlinzwa kwakho kuyadingeka noma cha noma ngabe kukhona yini ezinye izindlela zokwelashwa ezitholakalayo. Ngemuva kwaloko kuvela ukuphathwa kokusebenza kwakho futhi kuphi. Okokugcina, ingabe inkokhelo yakho izokhokhwa kangaki kumthethosivivinywa?
Akufanele uhlinzekwe noma yikuphi ukuhlinzwa noma inqubo yokukhetha ngaphandle kokubhekana nalezi zindaba kusengaphambili.
Njengento eminingi ngaphansi kwesambulela seMedare, akuwona konke okumnyama nokumhlophe. Bambalwa abantu abaqaphela ukuthi amaCenter for Medicare and Medicaid (CMS) asungule uhlu lwezinhlinzeko ezizobe zihlanganiswa yi-Medicare Part A ngenkathi ezinye izinhlinzeko, uma nje zingekho izinkinga, ezizenzakalelayo ku-Medicare Part B. Lokhu akuthinti kuphela kungakanani oyokhokha kodwa lapho ukuhlinzwa kwakho kungenziwa khona.
Uhlu lwezokwelapha lwe-Medicare lwe-Inpatient Only
Njalo ngonyaka i-CMS ikhishwa uhlu oluhlinzekwa olusha oluhlinzekwa iziguli kuphela. Ukuhlinzwa okwalolu hlu akukhethiwe ngokukhethwa kukho. Ngenxa yinkimbinkimbi yenkambiso, ingozi yezinkinga, isidingo sokuqapha kwe-post-operative, kanye nesikhathi esilindelekile sokuvuselela, i-CMS iyaqonda ukuthi lokhu kuhlinzeka kudinga ukunakekelwa okuphezulu.
Izibonelo zeziguli ezihlinzekwa ngokugula kuphela zifaka:
- Umthambo we-coronary uhambela ukuxhunyelelwa (i-CABG)
- Ukuhlinzekwa kwe-gastric forpass for obesity
- Ukulungisa i-valve yenhliziyo noma ukufaka esikhundleni se-valve
Ukuze kutholakale abahlomuli beMedare, ukuhlinzwa kufanele kwenziwe esibhedlela. I-Medicare Ingxenye A ihlanganisa izindleko eziningi zokuhlinzeka, futhi uzokhokha i-deductible ($ 1,316 ngo-2017).
Ukwelashwa Okwenziwe Emakilasini Okuhlinza Iziguli
Ukuhlinzwa okwenziwa ohlwini lwabantu abagulayo kuphela alukwazi ukuqhutshwa kwi-Ambulatory Surgery Center (ASC).
Eqinisweni, i-CMS ishicilela uhlu oluthile lwezokwelapha eziphuthumayo ezingenziwa e-ASC. Lolu hlu lubizwa ngokuthi yi-Addendum AA.
Ngencazelo, i-ASC iyisikhungo sezokwelapha esiphuthumayo lapho kwenziwa khona ukuhlinzwa. Kungenzeka noma kungabambisene nesibhedlela. Ungase uzwe ama-ASC abhekiselwa kuzo izikhungo zokuhlinzekwa kwezinsuku ezifanayo.
Ngokusho kwemihlahlandlela ye-CMS, "amakhodi okuhlinzekwa afakiwe kuhlu lwe-ASC yezinqubo zokuhlinzekwa ezihlinzekwayo yibo abazimisele ukubeka ingozi enkulu yokuphepha kubahlomuli beMedare uma behlinzekwe kuma-ASC futhi okungalindelekile ukuthi badinga ukuqapha kwezempilo okusebenzayo Phakathi kwamabili ngosuku lapho inqubo yokuhlinzwa eyenziwa khona (ukuhlala ubusuku bonke). "Mane nje, lezi zindlela zokuhlinza zingozi futhi azilindelekile ukuthi zidinga ukunakekelwa nokuqapha ngaphezu kwamahora angu-24.
Izibonelo zezinqubo ezingenziwa ku-ACS zihlanganisa:
- Ukususwa kwe-Cataract
- I-Colonoscopy ene-biopsy noma ngaphandle
- Umjovo we-epidural wezinhlungu zangemuva
- I-prostate biopsy
- Ukwelashwa kwe-Shockwave ngamatshe wezinso
Lezi zindlela zokuhlinza zizohlanganiswa ne-Medicare Part B, futhi uzokhokhiswa amaphesenti angu-20 azo zonke izindleko.
I-CMS Yokuhlinza Ukuhlinzeka Nokuphepha Kwesiguli
Uhlu oluhlinzekwa ngukugula kuphela lukhona kuphela ngokukhokha; kubuye nangokuphepha.
Ukusebenza esibhedlela kuhluke kakhulu kunalokho ku-ASC. Nakuba isibhedlela sinezinsiza zamahora angu-24, i-ASC kungenzeka isinciphise abasebenzi ubusuku bonke. Iningi le-ASC ngeke libe nodokotela kusayithi ngemva kwamahora.
Uma kunenkinga emva kwamahora, akunakwenzeka ukuthi i-ASC izoba nezinsiza ezifanele kanye nabasebenzi abatholakala ukuyilawula. Lokhu kungase kudingeke ukudlulisela isiguli esibhedlela esiseduze. Njengoba ukunakekelwa kwe-ASC kunqunyelwe ukuhlala kwamahora angu-24, uma isiguli sidinga isikhathi esengeziwe sokuthola, isiguli sidinga ukudluliselwa esibhedlela.
Ngalesi sizathu, zonke izinqubo zohlu lwe-Inpatient kuphela kufanele zenziwe esibhedlela.
Noma kunjalo, lokho akusho ukuthi ezinye izinhlinzeko ngeke zenziwe endaweni yezibhedlela. Uma ukuhlinzwa kungekho ohlwini lwezokwelapha kuphela kodwa hhayi kwi-addendum AA, kufanele futhi kwenziwe esibhedlela.
Ukuqhathanisa neMithi Yendabuko KuMuthi Wezokwelapha
I-Medicare yendabuko ( Ingxenye A neNgxenye B ) kanye ne- Medicare Advantage (Ingxenye C) landela imithetho ehlukile. Ngenkathi i-Medicare yendabuko ilandela yonke imihlahlandlela yokukhokha echazwe ngenhla, ama-Medicare Advantage amapulani awadingeki. Bangakhetha ukukhokhela ukuhlinzwa njengalesi sifo noma isiguli, okungukuthi ukhokhe okungaphezulu noma ngaphansi, kungakhathaliseki ukuthi bahlala kanjani ohlwini lwe-Inpatient kuphela. Lokhu kungabangela ubunzima bezezimali kuwe.
Kungakhathaliseki ukuthi uluhlobo luni lwe-Medicare onalo, ukuhlinzekwa kohlu lwe-Inpatient kuphela kufanele kwenziwe esibhedlela.
Kukhona izinzuzo zokuthola uhlelo lwe-Medicare Advantage. Cabanga ngokunakekelwa kokuvuselelwa ngemuva kokuhlinzwa kwakho. Ukuze i-Medicare yendabuko ikhokhele ukuhlala endaweni yokuhlengikaza enekhono, udinga ukuba ungeniswe okungenani izinsuku ezintathu ezilandelanayo njengesiguli. Izinhlelo ze-Medicare Advantage zinezinketho zokushiya ukubusa kwezinsuku ezintathu. Lokhu kungakusindisa kakhulu ezindlebeni zokuvuselela uma ukuhlala esibhedlela sekufushane kakhulu.
Izwi elivela
I-Medicare ayiphathe yonke imisebenzi yokuhlinzwa efanayo. Uhlu lokuhlinzeka kuphela oluhlinzeka ngesineke lukhishwa njalo ngonyaka nge-CMS. Lezi zinqubo zivunyelwe ngokuzenzakalelayo ukuze kutholakale Ingxenye A futhi kumele zenziwe esibhedlela. Zonke ezinye izindlela zokuhlinza, uma nje zingekho izinkinga, zihlanganiswe yiNgxenye B.
I-CMS iphinda ikhiphe i-Addendum AA yonyaka ecacisa ukuthi yisiphi isiguli (okungukuthi akuyona inqubo yokwelapha kuphela) engenziwa eNdaweni Yokuhlinza Emilenzeni. Bonke ukuhlinzwa okuphulukisiwe okuphuthumayo kumele kwenziwe esibhedlela kunoma ubani e-Medicare.
Thola ukuthi yiliphi iqembu inqubo yakho ewela ngaphambi kwesikhathi ukuze ukwazi ukuyihlela kangcono futhi ugweme ukucindezeleka okwengeziwe.
> Imithombo:
> Izikhungo zokuhlinza ngezifo. Amasevisi weMediare and Medicaid Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Kubuyekezwe ngo-Okthoba 20, 2016.
> Ikhodi ye-Electronic yeMithethonqubo kahulumeni: Isihloko 42 - Isahluko IV - Isiqeshana B - Ingxenye 416: Izinsizakalo Zokuhlinza Ezixilisayo. Ihhovisi le-US Government Publishing. https://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&sid=38af2161b33de70fc35286fdbee57ca6&rgn=div5&view=text&node=42:3.0.1.1.3&idno=42#PartTop. Kubuyekezwe ngo-Okthoba 12, 2017.
> I-FY 2017 I-IPPS Final Rule Homepage. Amasevisi weMediare and Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Ukugcina-Home-Page.html. Kubuyekezwe ngomhla ka-7 Mashi, 2017.
> Uhlelo lwe-Medicare: Isiguli esibhedlela IsiPhuzo Esithengiwe kanye Nezikhungo Ezihlinzekwayo Zokuhlinzeka Ngamazinga Okukhokha kanye nezinhlelo zokubika ngezinga eliphezulu. I-Federal Register. https://www.federalregister.gov/documents/2017/07/20/2017-14883/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment. Ishicilelwe ngo-Julayi 20, 2017.