Da'awar Biyan Kuɗi don Cibiyoyin Harkokin Jiki
Cibiyar Harkokin Cibiyar Aminci (ASC) ta bayyana ta hanyar CMS a matsayin kayan aiki tare da manufar kawai don samar da sabis na marasa lafiya ga marasa lafiya. Za a iya gano magungunan ƙwaƙwalwa a asibiti tare da asibiti na asibiti ko kuma iya zama cibiyar kula da ƙwaƙwalwa.
Yayin da ASC ta yi ikirarin cewa akwai wasu kamance da asibiti game da biyan kuɗi, akwai wasu bambanci daban-daban.
Dokokin Bayar da Bayar da Lambar ASC - Abin da Za A Yi amfani da Shi
Ma'aikatar cibiyar yanar gizo ta yanar gizo ta bada izini zuwa Medicare, Medicare Advantage Plans, da Medicaid a kan HCFA 1500 ko 837P. Wannan ya bambanta da aikin tiyata da ake yi wa masu biya, wanda aka sanya a kan UB-04 ko 837I.
CMS-1500 shine red-ink a kan takardun da'awar takarda mai tsabta takarda da likitoci da masu sayarwa ke amfani da su don biyan kuɗi. Duk wani mai bada sabis da mai ba da izini zai iya amfani da CMS-1500 don biyan kuɗi na lissafin kuɗi. Ana kiran layin lantarki na CMS-1500 da 837-P, P da ke tsaye ga tsarin sana'a.
UC-04 ko 837-I na amfani da ASC don yin bayanin ƙwaƙwalwar likita ga duk sauran masu biya.
Bill Type don ASC
Yayin da aka gabatar da ikirarin a kan UB-04, nau'in lissafin ASC ikirarin shine 83X. Lambar farko tana nufin nau'in kayan aiki: 8 - Gidajen Kwarewa, Asibiti ASC Surgery Na biyu lamba tana nufin ladabi na lissafin: 3 - Outpatient
Lambar na uku tana nufin mita wanda aka wakilta a sama da m X.
1 - Amincewa Ta hanyar Kayan Gida
7 - Sauya Tsohon Bayanin Kira ko Amincewa Kayan
8 - Cire ko soke wani takaddama na farko
Lambar Kuɗi
Lokacin da aka ba da amsa a kan UB-04, lambar ƙididdiga da aka yi amfani da shi don bayar da rahoton hanyoyin ƙwaƙwalwa ta hanyar kwastam ita ce 490.
Amfani da Masu gyara
ASC ikirarin yana iya zama da rikicewa saboda masu biyan kuɗi ba kawai buƙatar daban-daban na siffofin da'aƙan, su ma sun buƙaci amfani da daban-daban.
Medicare Modifiers
Medicare yana buƙatar waɗannan masu canzawa a yayin da suke yin rajistar wasu takaddun ka'idoji na ASC:
Gyara RT - A gefen dama (da aka yi amfani da hanyoyin da aka yi a gefen dama na jiki)
Modifier LT - Hagu na hagu (da aka yi amfani da su don gano hanyoyin da aka yi a hagu na jiki)
Gyara TC- Sashen fasaha
Gyara 52 - Rage ayyukan
Canji 59 - Tsarin raba hanya
Mai gyara 73 - An katse hanyar dabara bayan an fara yin aikin tiyata
Shirya 74 - An katse hanyar da aka yi bayan anesthesia aka gudanar
Gyara FB - Na'urar da aka ba da kyauta / cikakken bashi
Gyara FC - Na'urar da aka samar a m bashi
Gyara PA - Ƙaryaccen ɓangaren jiki
Gyara PB - Tiyata ba daidai ba ne
Gyara PC - Hanyar tiyata a kan haƙuri
Gyara PT - Binciken gyare-gyare na canzawa zuwa bincike ko aikin warkewa / tiyata
Gyara GW - Jirgin ba da alaka da marasa lafiya marasa lafiya marasa lafiya
Medicaid Modifier
Ko da yake Medicare yana amfani da waɗannan masu gyara, Medicaid baya buƙatar yin amfani da waɗannan daga cikin waɗannan. Abinda ya inganta don Medicaid yana inganta SG wanda ya bambanta da'awar azaman ƙwaƙwalwar cibiyar yanar gizo.
Yana da muhimmanci don shigar da SG zuwa kowace lambar CPT ba tare da la'akari da mai biya ba don ya bambanta lissafin kuɗin daga ƙwararren sana'a don wannan sabis ɗin.
Sauran Masu Gyara Masu Sanya
Wani misali na bambancin da ake amfani dasu shine Blue Blue Blue Shield ** yana buƙatar amfani da gyare-gyare 50, wanda ya bambanta hanya a matsayin hanya na biyu, tare da 2 raka'a sabis. Medicare, a gefe guda, yana buƙatar ko dai mai gyara 50 ko gyara RT da LT a kan wasu layi tare da 1 na sabis.
** Biyan kuɗi zai iya bambanta da jihar. Bincika tare da jagoran littafin BCBS don ganowa.