Makarantar sakandare na Medicare (MSP) wani ɓangare ne mai muhimmanci na mikawa da'awar da likitocin kiwon lafiya ya kamata su fahimta. Dokoki na iya zama haɗari. Ofisoshin kiwon lafiya cewa Dokar Medicare dole ne tabbatar da cewa ma'aikatan da suke da alhakin shiryawa da mikawa da'awar suna da cikakkiyar horarwa kuma suna ci gaba da bin ka'idoji da ka'idoji. Yi la'akari da halartar abubuwan horo da dama.
Menene MSP?
Medicare Secondary Payer ko MSP yana nufin Medicare amfanin lokacin da Medicare ba shine inshora farko. Medicare na buƙatar dukan masu kiwon lafiya su san yadda za su tantance lokacin da Medicare shine asibiti na farko ko na biyu don marasa lafiya na Medicare.
Sanar da CWF
CWF ko Kayan aiki na Kasuwanci shi ne aikace-aikacen Medicare wanda ke kula da bayanan da ake bayarwa game da ɗaukar hoto ga masu lafiya Medicare . Tabbatar ku duba CWF koyaushe don nazarin bayanin MSP don samun asibiti na asibiti.
Marasa lafiya ga wanda Medicare ne mai biyan bashi
Medicare shine mai biya bashi ga mai haƙuri wanda ya sadu da waɗannan bukatun:
- 65 ko tsufa kuma yana da tsarin kula da lafiyar kananan kungiyoyi ta hanyar mai aiki na yanzu ko ta hanyar ma'aikaci na yanzu
- 65 ko mazan tare da inshora ta hanyar shirin ritaya
- Ƙashirwa kuma yana da tsarin kula da lafiyar kananan kungiyoyi ta hanyar mai aiki na yanzu ko ta hanyar ma'aikaci na yanzu
Marasa lafiya ga wanda Medicare ne mai biyan bashin
Medicare shine mai biya na biyu don mai haƙuri wanda ya sadu da waɗannan bukatun:
- 65 ko tsufa kuma yana da babban tsarin kiwon lafiyar jama'a ta wurin ma'aikata na yanzu ko ta hanyar ma'aikaci na yanzu
- Dama kuma yana da babban tsarin kiwon lafiyar jama'a ta wurin mai aiki na yanzu ko ta hanyar ma'aikaci na yanzu
- Ma'aikaci ya rufe shi
- An rufe shi ta hanyar hadari ko asusun inshora
Menene Medicare Yayi Idan Asusun Farko ya Karyata Da'awar?
A lokuta cewa inshora na farko ya musun da'awar, Medicare na iya biyan bashin kawai saboda wasu dalilai na ƙaryata, kamar:
- Manufofin mai biyan kuɗi sun ƙare
- Ma'aikata ya ƙayyade cewa ba a rufe ayyukan ba
- Asibiti na hatsari ko abin alhaki ya musun ko daukan dogon lokaci ya biya. Mai bada sabis na iya zama cancanci biya biyan kuɗi idan an sa iƙirarin ɗaukar lokaci mai yawa don biyan kuɗi.
Amfani da Yanayin Lambobi FL 18-28
Lamba na 02: Yanayi shine aikin aikin
Code 03: Moriyar da inshora ba ta nuna a nan
Code 05: An sanya layi
Lamba na 06: Ciwon ESRD a cikin farkon watanni 30 da suka cancanta
Lambar 08: Mai Aminci ba zai bayar da bayanai game da wani haɗin inshora ba
Code 09: Babu haƙuri ko ma'aurata suna aiki
Lamba na 10: Mai haƙuri da / ko mata suna aiki amma ba'afin EGHP ya wanzu ba
Lamba na 11: Masiha mai cin nasara amma ba LGHP ɗaukar hoto
Lamba na 28: Mai haƙuri da / ko matar EGHP shine na biyu
Lamba na 29: Abokan mai ladabi da / ko LGHP memba na iyali shine na biyu zuwa Medicare
Lambar 77: Mai bada sabis ya karɓa ko wajibi ne / ake buƙata saboda yarjejeniyar kwangila ko doka don karɓar kuɗin da mai biyan bashi ya biya a matsayin cikakken kuɗi. Ba'a biya Asusun Medicare ba.
Amfani da Codes na Farko FL 31-34
Code 01: Cutar da aka samu - mai biyan bashin likita
Lamba na 02: Babu haɗin ƙetalar aiki (amfani da lamba mai lamba 14)
Lamba na 03: Tashin hankali - alhaki (amfani da lamba mai lamba 47)
Lamba na 04: Cutar haɗari - haɗin gwiwar aiki (amfani da lamba mai lamba 15)
Code 06: Laifi wanda aka azabtar
Lambar 18: Ranar mai haƙuri / mai karɓa
Lambar 19: Kwanan ranar ritaya ta mata
Lamba na 24: An hana kundin kwanan wata
Lambar 33: Ranar farko ta lokacin haɗin gwiwar masu amfani da ESRD wanda EGHP ya rufe
Lambar A3: Mai Biyan kuɗi A amfanin ya ƙare
Amfani da Codes Lamba FL 39-41
Shigar da adadin kuɗin da Payer A aka saita a FL 50 don Codes 12 - 43:
Lamba na 12: Yin aiki na ɗan shekara mai aure ko mata
Lamba na 13: ESRD yana amfana a cikin tsawon watanni 30
Lamba na 14: Bincike marar laifi wanda ya haɗa da auto
Lamba na 15: Hakkin ma'aikata
Lamba na 16: Ayyukan kiwon lafiya na jama'a ko wasu hukumomin tarayya kamar su laifin da aka azabtar, gwajin magani, da dai sauransu.
Code 41: Kwayar fata
Lamba na 42: Gwamnatin Tsoro
Lamba na 43: Mai cin moriya a karkashin shekara 65 tare da LGHP
Lamba na 44: Mai karɓar mai karɓa ya yarda ya karɓa daga mai biya na farko idan wannan adadin ya zama ƙasa da caji amma ya fi yadda aka biya, to, mai biya na sakandare na Medicare ya cancanci. Shigar da adadin da kuka amince da ko kuma wajibi ne ku karɓa.
Lamba na 47: Haɗiya inshora
Amfani da Lambobin Sadarwa FL 59
Code 01: Ma'aurata
Code 04: Kakan / kakar
Code 05: Grandson / jikoki
Lamba na 07: ɗan'uwa / mahaifi
Lamba na 10: Ci gaba da jariri
Code 15: Ward
Lamba na 17: Stepson / stepdaughter
Code 18: Kai
Code 19: Yaro
Code 20: Ma'aikaci
Lamba na 21: Ba a sani ba
Lamba na 22: Rashin lafiyar dogara
Lamba na 23: Tallafin tallafi
Lamba na 24: Dangane da ƙananan masu dogara
Lambar 29: Mai mahimmanci
Code 32: Uwar
Lambar 33: Uba
Lamba na 36: Ƙaramin ƙananan
Code 39: Organ donor
Code 40: Cadaver donor
Code 41: Mai wahalar da ake tuhuma
Lamba na 43: Yaro wanda aka sanya shi ba shi da alhakin kudi
Code 53: Abokiyar rayuwa
Code G8: Sauran dangantaka
Ziyarci Shawarar Magana ta Medicare a shafin yanar gizon cms.gov don cikakken jerin dukkan lambobin lissafin kuɗi.