Kuvhiya kwako kuchaita urongwa here?
Pane zvinhu zvakawanda zvaunofunga kufunga nezvazvo usati waenda pasi petipa. Yokutanga, hongu, ndeyekuti kana kwete chirwere chako chakakosha here kana pane dzimwe nzira dzokurapa dziripo. Mushure mezvo izvi zvinouya maitiro ekuti uye sei uye kuvhiyiwa kwako kuchaitwa sei. Pakupedzisira, inshuwarisi ichabhadhara zvakadini kumutemo?
Iwe haufaniri kuita chero upi noupi hunoshandiswa pakusarudza kana nzira kunze kwekutarisa nyaya idzi zvisati zvaitika.
Kufanana nezvinhu zvakawanda pasi peMambure yeMedarera, kwete zvose zvinotema uye zvichena. Vanhu vashomanana vanoziva kuti Centers for Medicare neMedicaid (CMS) yakagadzira urongwa hwekuvhiya huchafukidzwa neMurereti weAA apo mamwe mavhivhi, chero bedzi pasina madambudziko, kusingagumi kune Medicare Chikamu B. Izvi zvinosanganisa kwete chete kuti iwe uchabhadhara zvakadini asi apo kuvhiyiwa kwako kunogona kuitwa.
Medicare's Inpatient Only Surgery List
Gore roga roga CMS inodzinga runyorwa ruchidzokidzwa muongorori chete rwekuvhiya. Kuvhiyiwa pane urongwa hakusi kusarudzwa kusarudzwa. Pamusana pekuoma kwemaitiro acho, njodzi yezvinetso, chido chekugadziriswa kwemashure, uye nguva inotarisirwa kwenguva yakareba yekugadzirisa, CMS inonzwisisa kuti kurapwa uku kunoda huwandu hwekutarisira.
Mienzaniso yekurapa kwepfungwa chete inosanganisira:
- Coronary artery bypass grafting (CABG)
- Gastric inpass chirurgical for obesity
- Kugadziriswa kwemagetsi yemhepo kana kushandiswa kwemagetsi
Nokuda kwekuchengetedzwa kweVabatsiri veMedare, mavhivhi aya anofanira kuitwa muchipatara. Medicare Chikamu A inobata mari zhinji yekuvhiya, uye iwe uchabhadhara deductible ($ 1,316 muna 2017).
Zvokuvhiya Zvakaitwa Muzvipatara Zvokuvhiya
Kuvhiya pamusoro pezvipembenene chete zvinongororwa hakugoni kuitwa muAmbulatory Surgery Center (ASC).
Zvechokwadi, CMS inoparidzira ruzivo rwakasiyana rwekuvhiya kwekunze kunze kunogona kuitwa paA ASC. Iri rondedzero rinotumidzwa seAdendendum AA.
Nenzira, ASC ndiyo chirwere chekurapa chiri kunze kwepasi apo kuvhiyiwa kunoitwa. Inogona kana kuti isingave yakabatana nechipatara. Iwe unogona zvakare kunzwa ASCs dzinonzi masikati anovhiyiwa.
Maererano nemitemo yeCMS, "nheyo dzekuvhiya dzinosanganiswa paACC urongwa hwekuvhiyiwa huripo ndeye avo vakagadzirirwa kusaisa mungozi kune avo vanopiwa Medicare kana vakagadzirirwa muAASC uye izvo zvisingatarisirwi kutoda kurapwa kwechirwere pakati peusiku wezuva apo chirongwa chacho chinoshandiswa (kurara kweusiku humwe chete). "Zvichingoti, kuvhiyiwa uku ndiko ngozi shoma uye hazvidi kutarisirwa uye kutarisa kupfuura maawa makumi maviri nemaviri.
Mienzaniso yemitemo inogona kuitwa mu ACS inosanganisira:
- Cataract kubviswa
- Colonoscopy kana kuti pasina biopsy
- Epidural injection yemarwadzo ekudzokera shure
- Prostate biopsy
- Shockwave therapy yeminyo yemabwe
Aya mavhivhi achave akafukidzwa neMurereti B, uye iwe uchakweretwa 20 muzana yezvose zvinodhura.
CMS Surgery Lists uye Patient Safety
Inoratidzi rwekurapa chirwere chekuvhiya chete haisi kungobhadhara chete; iyo ndeyekuchengeteka.
Kushanda muchipatara zvakasiyana kwazvo pane izvo zviri muA ASC. Kunyange zvazvo chipatara chiri nemaawa makumi maviri nemasere, ASC inogona kuderedza vashandi usiku hwose. Mazhinji ASC haazove nachiremba pa-site mushure meawa.
Kana pane dambudziko shure kwemaawa, hazvigoneki kuti ASC inogona kuva nemafungiro akanaka uye vashandi vanogona kuitakura. Izvi zvingada kuendesa murwere kuchipatara chiri pedyo. Sezvo kutarisirwa muAAC kunongopera kwemaawa 24 chete, kana murwere aida nguva yakawanda yekudzorera, murwere angadawo kutumirwa kuchipatara.
Nokuda kwezvikonzero izvi, mitemo yose yeInpatient Only list inofanira kuitwa muchipatara.
Zvisinei, izvozvo hazvirevi kuti mamwe mavhivhi haazoitike muchipatara. Kana chirwere chisina kuwanikwa mune-inpatient-chete urongwa uye kwete pane addendum AA, inofanirawo kuitwa muchipatara.
Kuenzanisa Chirwere Chetsika kuMutare Inobatsira
Traditional Medicare ( Chikamu A uye Chikamu B ) uye Medicare Advantage (Chikamu C) kutevera mitemo yakasiyana. Kunyange zvazvo mishonga yemagariro inotevera mitemo yose yekubhadhara yakarondedzerwa pamusoro, Medicare Advantage zvirongwa hazvifaniri. Vanogona kusarudza kubhadhara kurapwa sevanorwara kana varwere, kureva kuripa zvakanyanya kana zvishoma, pasinei nokuti vari kuInpatient Only list. Izvi zvinogona kuunza dambudziko rezvemari kwauri.
Pasinei nokuti rudzi rweMedare rinoronga chii, chirwere cheInpatient Only list chinofanira kuitwa muchipatara.
Ikoko kunogona kuva zvakanaka kune chirongwa che Medicare Advantage. Funga nezvekuchengetedzwa kwekuvandudza mushure mekuvhiyiwa kwako. Kuti zvizvarwa zveMedarere zvibhadhara kuti ugare mune unyanzvi hwekurapa unyanzvi, unofanirwa kubvumirwa kwekuda kwemazuva matatu ekutevera semutachiona. Medicare Makomborero mazano ane sarudzo yekuregera kutonga kwemazuva matatu. Izvi zvinogona kukuchengetedza zvakanyanya mumari yekudzorera kana chipatara chako chikaramba chiri pfupi munguva yakareba.
Shoko Rinobva
Medicare haina kubata mavhivhi ose zvakafanana. Chirwere chekushaya chirwere-chirwere chete chinosunungurwa gore roga roga neCMS. Aya maitiro anowanzotenderwa kuti Chikamu A chigoverwe uye chinofanira kuitwa muchipatara. Mamwe mavhivhi ose, chero bedzi pasina matambudziko, akafukidzwa neChikamu B.
CMS inoburitsawo gore reAdendendum AA yegore negore inotsanangura kuti chii chinonzi kunze (kureva kwete chirwere-chete) zvinogona kuitwa muAmbulatory Surgery Centers. Zvose zvakasara zvekuvhiya kunze kwechipatara zvinofanira kuitwa muchipatara kune ani zvake muMedare.
Tsvaga kuti ndeboka ripi raunofambisa rinowira mberi kwenguva kuitira kuti iwe unogona kurironga zviri nani nekudzivisa zvimwe zvinetso.
> Sources:
> Chirwere Chirwere Chirwere. The Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/ASCs.html. Yakapedzwa musi waOctober 20, 2016.
> Electronic Code of Federal Regulations: Chinyorwa 42 - Chitsauko IV - Chikamu chechipiri B - Chikamu 416: Mazano ekuvhiya anobvumira. US Government Publishing Office. 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. Yakaperedzwa Gunyana 12, 2017.
> FY 2017 IPPS Yokupedzisira Rule Homepage. The Centers for Medicare and Medicaid Services. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/FY2017-IPPS-Final-Rule-Home-Page.html. Yakarongwa musi waMarch 7, 2017.
> Medicare Program: Hospital Outpatient Zvichida Kubhadhara uye Chirwere Chekuvhiya Chirongwa Chekubhadhara Zvikwereti uye Hurongwa Hwekupa Hurukuro. Federal Register. https://www.federalregister.gov/documents/2017/07/20/2017-14883/medicare-program-hospital-outpatient-prospective-payment-and-ambulatory-surgical-center-payment. Yakabudiswa musi waJuly 20, 2017.