Kuskuren Coding zai iya biya ku Kudi
Ana amfani da lambobin inshora ta tsarin lafiyar ku don yin yanke shawara game da yadda za ku biya likitanku da sauran ma'aikatan kiwon lafiya. Yawancin lokaci, za ku ga waɗannan lambobin akan bayaninku na Amfani da takardar kudi na likita.
Bayani na Amfanin (EOB) wani nau'i ne ko takardun da kamfanin inshora zai iya ba ku a makonni da dama ko watanni bayan kuna da sabis na kiwon lafiya wanda kamfanin inshora ya biya.
Your EOB ne taga a cikin tarihin lissafin kuɗin lafiya. Yi la'akari da shi a hankali don tabbatar da an sami sabis ɗin da aka biya, adadin likitan da aka karɓa da kuma rabo ɗinka daidai ne, da kuma cewa an gane asalinka da hanyarka kuma an tsara su.
Muhimmancin Lambobin Assurance
EOBs, siffofin dabarun inshora, da takardun likita daga likitanku ko asibiti na da wuya a fahimta saboda yin amfani da lambobi don bayyana ayyukan da aka yi da ganewar ku. Ana amfani da wadannan ka'idojin maimakon harshen Turanci kuma yana iya zama da amfani a gare ka ka koyi game da waɗannan lambobin, musamman ma idan kana da matsalar daya ko fiye da lafiya.
Alal misali, miliyoyin jama'ar Amirka suna da ciwon sukari na 2 tare da cutar hawan jini da kuma high cholesterol. Wannan rukuni na mutane suna da karin hidimar kiwon lafiya fiye da matsakaitan Amurka kuma, sabili da haka, za su buƙaci sake duba karin takardun EOB da takardun magani.
Coding Systems
Shirye-shiryen kiwon lafiya, kamfanoni masu biyan kuɗi, da masu kiwon lafiya suna amfani da tsarin tsaftace daban daban. An tsara waɗannan lambobin don tabbatar da cewa akwai hanyoyin da za su iya dogara ga kamfanonin inshora na kiwon lafiya su aiwatar da ƙididdiga daga ma'aikatan kiwon lafiya da kuma biyan kuɗin kiwon lafiya.
Hanyar Tsarin Hanya na Yanzu
Ana amfani da ka'idojin ka'idojin hanyoyin yau da kullum (CPT) masu likita don bayyana ayyukan da suke samarwa. Ba'a biya ku likitan ku ta hanyar kiwon lafiyarku ba sai dai idan an rubuta lambar CPT a kan takardar shaidar.
Lambobin CPT an bunkasa su kuma sun sabunta su ta Cibiyar Harkokin Kiwon Lafiya na Amurka (AMA). Abin baƙin ciki shine, AMA ba ta samar da damar shiga cikin lambobin CPT ba. 'Yan kasuwa na kiwon lafiya waɗanda suke amfani da lambobin dole ne su saya littattafai na coding ko samun damar yanar gizon lambobin daga AMA.
Tashar AMA ta baka damar bincika lambar ko sunan hanyar. Duk da haka, ƙungiyar ta ƙayyade ku zuwa fiye da 5 bincike a kowace rana (dole ku ƙirƙiri lissafi kuma ku shiga don ku iya amfani da siffar binciken). Har ila yau, likitanku na iya samun takardar (wanda ake kira jigon haɗuwa ko kuma "superbill") wanda ya tsara CPT mafi yawanci da ka'idojin ganewa a cikin ofishinsa. Gidan likitanku zai iya raba wannan tsari tare da ku.
Wasu misalan lambobin CPT sune:
- 99201 - Ofisoshin ko wasu masu kulawa da su don dubawa da kuma kula da sabon likita
- 93000 - electrocardiogram
- 36415 - tarin jini mai zubar da jini ta venipuncture (zubar da jini)
Harkokin Kiwon Lafiyar Kwayoyin Kulawa da lafiya
Shirin Kulawa na Kula da Lafiya na Kullum (HCPCS) shine tsarin tsarin da Medicare yayi.
Sakamakon matakin HCPCS na matakin daidai yake da lambobin CPT daga Ƙungiyar lafiya ta Amirka.
Medicare kuma yana kula da saitin lambobin da ake kira HCPCS Level II. Ana amfani da waɗannan lambobin don gano samfurori, kayayyaki, da kuma ayyuka ba a cikin lambobin CPT ba, irin su sabis na motar asibiti da kayayyakin kiwon lafiya mai dorewa (gadaje da gadajen asibiti), masu haɗiya, kothotics, da kuma kayan da ake amfani da shi a ofishin likitan ku.
Wasu misalan lambobin HCPCS na matakin II sune:
- L4386 - tafiya ne
- E0605 - bazawa
- E0455 - oxygen alfarwa
Cibiyoyin Kula da Magunguna da Medicaid suna kula da shafin yanar gizon da aka samar da bayanin HCPCS a cikin jama'a.
Kayan Kayan Ƙasa na Duniya
Hanya na uku na coding shine Kayan Ƙasa na Ƙasashen Duniya, ko Lambobin ICD. Wadannan ka'idoji, Cibiyar Lafiya ta Duniya (WHO) ta haɓaka, gano lafiyar ku, ko ganewar asali. Ana amfani da lambobin ICD da haɗe da lambobin CPT don tabbatar da lafiyar lafiyar ku da kuma ayyukan da kuka samu.
Alal misali, idan ganewar asalinsa shine mashako kuma likitanka ya ba da umarnin X-ray ankle, yana yiwuwa watau X-ray ba za a biya ba saboda ba shi da dangantaka da mashako. Duk da haka, nau'in X-ray yana dace kuma za'a sake biya.
Wasu alamun lambobin ICD-10 sune:
- E66.0 - kiba saboda calories wuce haddi
- F32.0 - m bakin ciki
- S93.4 - ƙwanƙwasa takalma
Kundin jerin lambobin bincike (wanda aka sani da ICD-10) yana samuwa don saukewa daga shafin yanar gizon CMS, kuma ICD10data.com ya sa ya dace sosai don bincika lambobin daban.
{Asar Amirka ta canja daga ICD-9 zuwa dokokin ICD-10 a 2015, amma sauran tsarin kula da lafiyar zamani a duniya sun aiwatar da ICD-10 shekaru da yawa a baya. Lambobin CPT suna ci gaba da amfani da su tare da lambobin ICD-10 (dukansu suna nunawa a kan ƙididdiga na likita), saboda lambobin CPT suna biyan kuɗi, yayin da lambobin ICD-10 sune don samo asali.
Coding Kurakurai
Yin amfani da tsarin lambobi uku zai iya zama damuwa ga likitan likita da ma'aikatan asibitin masu aiki kuma yana da sauƙin fahimtar dalilin da yasa kuskuren coding ya faru. Saboda tsarin kiwon lafiyar ku yana amfani da lambobin don yanke shawara game da yadda za ku biya likitanku da sauran ma'aikatan kiwon lafiya, kuskuren zai iya biya ku kudi.
Lamba mara kyau ba zai iya lakafta ku da yanayin kiwon lafiyar da ba ku da shi (akwai damuwa da cewa yanayin da suka rigaya ya iya zama abin hanawa don samun lafiyar lafiya a karkashin GOP na kokarin sake safarar kiwon lafiyar), haifar da ƙarin biya ga likita kuma yiwuwar ƙara yawan kuɗin kuɗin kuɗi , ko shirin lafiyar ku na iya ƙaryar da'awar ku kuma ba ku biya wani abu ba. Yana yiwuwa ga likitanku, ɗakin gaggawa, ko kuma asibiti don yin kuskuren ayyukan da kuka karɓa, ko dai ya tsara kuskuren ganewar ko kuskuren hanyoyi. Ko da mawuyacin kurakuran rubutu na iya samun sakamako mai mahimmanci.
Alal misali: Doug M. ya fadi yayin da yake jingina. Saboda ciwo a idonsa, sai ya tafi wurin gaggawa na gida. Bayan samun X-ray na idonsa, likitancin likita na Likita ya binciko idon takalma kuma ya tura Doug gida ya huta. Bayan makonni da yawa sai Doug ya sami lissafi daga asibiti don fiye da $ 500 don X-ray. Lokacin da EOB ya iso, sai ya lura cewa shirin lafiyarsa ya ƙaryata game da ikirarin X-ray.
Doug ya kira tsarin lafiyarsa. Ya ɗauki ɗan lokaci don gyara kuskure da mai yin rajista ya yi a cikin dakin gaggawa. Ta ba da gangan ta sa lambar da ba daidai ba a cikin lambar ganewar ganewar Doug, ta canza S93.4 (ƙwanƙwasa takalma) zuwa S53.4 (ƙwaƙwalwar hannu). Maganin lafiyar Doug ya ƙaryata game da wannan da'awar saboda X-ray na idon ba jarrabawar da ake yi ba lokacin da wani ya samu rauni.
Akwai matakan da dama a cikin aiwatar da cikawa da kuma mika wani da'awar likita. Tare da hanyar, mutane da kwamfutar da suka shiga cikin tsari zasu iya yin kuskure. Idan an hana iƙirarinka, kada ka ji kunya game da kiran likitan likitanka da shirin lafiya naka.
> Sources:
> Ƙungiyar lafiya ta Amirka. Binciki Coding Resources.
> Bohnett, Charlotte. Tsara. 8 Abubuwa da kuke buƙatar sani yanzu game da ICD-10. Yuli 2013.
> Cibiyar Kula da Magungunan Magunguna da Magungunan Medicaid. HCPCS Taitaccen Tsarewa.
> ICD10data.com. Shafin yanar gizo na Free 2018 ICD-10-CM / PCS.