Yeka indlela i-DRG inquma ngayo ukuthi Isibhedlela siyithola kanjani

I-Medicare kanye nezinkampani ezithile zomshuwalense wezempilo zangasese zikhokhela izibhedlela zabahlinzeki babo ngokusebenzisa uhlelo lokukhokha lwe-DRG . Ngaso sonke isikhathi uma usungulwa njengesiguli esibhedlela, leso sibhedlela sinikeza i-DRG kulowo mvume. Isibhedlela siyakhokhwa inani elilinganiselwe laleyo-DRG, kungakhathaliseki ukuthi imali engakanani isebenza ngempela ukukuphatha. Uma isibhedlela singakuthola ngokuphumelelayo ngemali encane kunokuba iMareare iyikhokhele i-DRG yakho, bese isibhedlela senza imali kulolo gciwane.

Uma isibhedlela sichitha imali eningi ekunakekeleni kunokuba iMedricare inikezele i-DRG yakho, isibhedlela silahlekelwa imali kuleso sibhedlela.

Funda kabanzi mayelana nalokhu ku-" DRG 101: Iyini i-DRG & Isebenza Kanjani? "

Ukuze ubone ukuthi isibhedlela siyakhokhwa kangakanani kunoma yikuphi ukunakekelwa esibhedlela, kufanele wazi kuqala ukuthi i-DRG inikezelwe yilezi zikhungo . Ngaphezu kwalokho, kufanele wazi isilinganiso esibanjwe esibhedlela. Shayela umnyango wokukhokhisa, ukubalwa kwezimali, noma umnyango wezokuphathwa kwamacala esibhedlela bese ubuza ukuthi imishanguzo yayo ihlanganisiwe nani.

Ukuqaphela ukuthi Imali Ingakanani Isibhedlela Ithola Ukukhokhelwa I-DRG Enikeziwe

I-DRG ngayinye inikezwa isisindo esilandelayo esekelwe inani elilinganiselwe lemithombo edingekayo ukunakekela isiguli esinikezwe kuleyo DRG. Ungabheka isisindo esinqunyiwe se-DRG yakho ethile ngokulanda ishadi elihlinzekwe yi-Centers for Medicare neMedicaid Services kulandela le miyalo:

1. Hamba kuleli khasi lewebhu kuwebhusayithi ye-CMS.
2. Skrolela phansi phansi kwekhasi. Thola indawo enesihloko esithi "Ukulanda."
3. Landa ithebula 5.
4. Vula ifayela elibonisa ulwazi njengeSpredishithi ye-Excel (ifayela eliphela nge ".xlsx".)
5. Ikholomu ebizwa ngokuthi "izisindo" ibonisa isisindo esiphezulu se-DRG ngayinye.

Isisindo sesihlobo esilinganiselwe ngu-1.0. I-DRG enesisindo esincane esingaphansi kuka-1.0 sinamandla kakhulu okuphatha futhi ngokuvamile ayabiza kakhulu ukuphatha. I-DRG enesisindo esilinganiselwe ngaphezu kuka-1.0 ngokuvamile idinga izinsiza eziningi zokwelapha futhi ziyabiza kakhulu ukwelapha. Njengoba ephakeme isisindo esinqunyiwe, kukhona izinsiza ezidingekayo zokwelapha isiguli ne-DRG.

Ukuze uthole ukuthi imali yakho isibhedlela sakho ikhokhwe kangakanani, kufanele ukwandise isisindo sakho se-DRG ngesilinganiso sakho esibanjwe esibhedlela. Nasi isibonelo esibhedlela esibangelwa u-$ 6,000 uma isisindo sakho se-DRG singu-1.3:

$ 6,000 X 1.3 = $ 7,800. Isibhedlela sakho sekhokhwe imali engu- $ 7,800 ukuze uthole esibhedlela.

I-Blended Rate Blended isebenza kanjani?

Njengoba izindleko zokunakekelwa kwempilo nezindleko zabasebenzi ziyahlukahluka ezweni lonke futhi ngisho nasezibhedlela kuya esibhedlela, uMedare unikeza isilinganiso esihlukile esibhedlela ngasinye esamukela i-Medicare. Isibonelo, isibhedlela saseManhattan, eNew York City cishe sinemali ephezulu yokusebenza, izindleko eziphakeme zokugcina indawo yayo, nezindleko eziphezulu ezingaphezulu kwesibhedlela eKnoxville, eTennessee. Isibhedlela saseManhattan cishe sinesilinganiso esiphezulu kunazo zonke esibhedlela saseKnoxville.

Ezinye izinto uM Medicare ezibhekayo ekunqumweni kwezinga elihlanganisiwe esibhedlela zifakazela ukuthi noma ngabe yini esibhedlela sokufundisa nabahlali nabangaphakathi, kungakhathaliseki ukuthi yini endaweni yasemaphandleni noma ngabe kungakhathaliseki yini ukuthi unakekela ingxenye engafaniyo yabantu abampofu nabangagciniwe. Ngayinye yalezi zinto zandisa ukwanda kwesibhedlela esibanjwe.

Ngomhla ka-Okthoba, i-Medicare isinika zonke izibhedlela isilinganiso esisha esihlanganisiwe. Ngale ndlela, i-Medicare ingakwazi ukulungisa ukuthi likhokhela noma yiliphi isibhedlela esinikeziwe esisekelwe nje ekuthambekeni kwamanye amazwe njengamanani emali, kodwa nakwezinye izimo zesifunda. Isibonelo, njengendawo yendawo isuke ithuthukiswe ngokwengeziwe, isibhedlela ngaphakathi kwaleyo ndawo ingase ilahlekelwe ukubizwa kwayo yasemaphandleni.

_Imithombo:

_{I-Federal Register, i-Medicare Program; IziNhlelo Zokukhokhela Iziguli Ezibhekene Nezifo Eziphuthumayo Izibhedlela Zokunakekelwa Okunakekelwayo kanye neSibhedlela Sesikhathi Esijwayelekile Sokunakekelwa Kwezingqalasizinda Izinkokhelo Nonyaka Wezimali 2016 Amanani; Ukubuyekezwa Kwezimfuneko Zokubikwa Kwekhwalithi Kubanikezeli Abacacile, Kufaka Izinguquko Ezihlobene nohlelo lwe-Electronic Health Record Incentive Program; Izandiso ze-Medicare-Dependent, Uhlelo lweSibhedlela Esincane Esisemakhaya kanye Nokulungiswa Kwezindleko Eziphansi Kwemibandela yezibhedlela, 8/17/15.}