Mhinduro yakarurama inobva pane dzakawanda zvikamu. Kuramba uchienda kune rimwe zuva pamagetsi ekunyorwa kwekodhi, kutevera maitiro akachengetedzwa kwekodhi nekuchengetedza zvinyorwa zvevarwere zvakajeka nzira dzinoshandisika dzekuti zvirongwa zvehutano zvehutano zvive zvakarurama.
Ikokunyorwa kweMurengeti weMedare kune zvakasiyana-siyana zvezvinotarisirwa izvo vashandi vanogona kutaura nezvekudzivirira kukodha kunoratidzirwa kukanganwa kana kukwereta kusina kukodzera.
Iri rinyo rekunyorwa kwekodhi rinonzi NCCI kana CCI mutemo wemishonga ye Medicare.
National Correct Coding Initiative (NCCI) yakagadzirwa neCenters of Medicare neMedicaid Services (CMS) kudzivirira Medicare isina kukodzera pamusana pekukanganisa kwekodhi.
Pane mitatu yeCCCI inogadziriswa:
- Nzira yekugadzirisa-ku-nzira inogadziriswa
- Mishonga haigoni kuchinja
- Add-on on the code edits
Maererano neCMS, mitemo yeCCCI yakagadziriswa inosarudzwa uye inobva mukubatanidzwa kwemitemo yakasiyana-siyana yekodha kusanganisira:
- Ikozvino Procedural Terminology (CPT) Manual neAmerican Medical Association's (AMA)
- Mazano emunharaunda uye munyika yose
- Nhepfenyuro dzehurumende dzevanhu
- Maitiro ekurapa maitiro
- Nhasi coding maitiro
Nzvimbo yewebhu yeCMS inopa huwandu hwezvigadzirwa zvevashandi kuti vakwanise kunyatsogadzirisa zvikwereti zvekurapa.
- National Correct Coding Initiative Policy Manual ye Medicare Services
- NCCI inogadziriswa inoshandiswa kumitambo yevashandi
- NCCI inoshandiswa kushandiswa kwezvipupuriro zvechipatara zvepachipatara muPatpatient Code Editor (OCE)
- NCCI Inowanzobvunzwa Mibvunzo (FAQ)
- MUE Overview
- MUE Mibvunzo Inowanzobvunzwa (FAQ)
- HCPCS / CPT nhamba dzakashambadzirwa mararamiro eMUE muTractitioner / DME Supplier MUE tafura
- HCPCS / CPT nhamba dzakashambadzirwa mararamiro eMUE muPatapi Outpatient Services MUE tafura
- HCPCS / CPT nhamba dzakashambadzirwa mararamiro eMUE muDurable Medical Equipment (DME) Masevisi eMutengesi MUE tafura
- Nhasi purogiramu yeiyo inovandudzwa inoshandurwa ye NCCI yakarongwa uye yakabudiswa MUEs
- Medicare Learning Network Kuparidzirwa: "Medicare Claim Review Programme: MR, NCCI Editing, MUEs, CERT, uye Recovery Audit Program"
- Medicare Learning Network Kutaurirwa: "Mashandisiro Aungaita National National Correct Coding Initiative (NCCI) Tools"
NCCI: Nzira-ku-Nzira Dziripo
NCCI nzira-kusvika-nzira yakashandurwa inoshandiswa kune zvose zviripo CPT uye HCPCS nzira dzekuita.
Nhamba dzeCPT dzinowanzoita maitiro ehurumende uye dzakagadziridzwa uye dzinozivikanwa neAmerican Medical Association muna 1966. Idzi inzira yezvishanu zvinyorwa zvinyorwa zvinyorwa zvinyorwa zvinotsanangurwa mune nzira yakarongeka yezvechiremba, yekuvhiya, uye yekuongorora zvirongwa.
HCPCS kana Healthcare Common Procedure Coding System mazinga I uye II. Nhamba I ine maPCT, uye Nhamba II inosanganisira alphanumeric nheyo dzinoshandiswa kugadzira zvigadzirwa, zvigadzirwa, uye mabasa asina kuiswa mumitemo yeCPT paanoshandiswa kunze kwehofisi yechiremba.
NCCI nzira-kusvika-nzira inogadziriswa inodzivisa kuburitsa uye kubhadhara kwebasa risingafaniri kukweretwa pane kudai pamwe chete. NCCI inogadziriswa inogona kuwanikwa pamatafura mana anowanikwa pawebsite yeCMS.
Iyi matafura ndeyekutaura nezvezvipatara uye vanachiremba kuti vaone zvikamu zvemitemo zvisingagoni kutumirwa pamusana pekutaura kumwechete kana kuti zvakabatana. Kana kudai kwaiva nemitemo yese, kune zviitiko zviviri zvinogona kuitika:
- Zvichienderana nekuti code yacho yakanyorwa muhurukuro 1 kana kuti korome 2 yetafura, iyo chinyorwa 2 code icharamba. Muenzaniso: Mubatsiri haafaniri kutaurira unilateral kuongorora mammogram neyemamwe maitiro ekufungisisa mammogram. Iko kusagadziriswa kwekubatana kwemasimba hakuzokwanisi kubhadhara.
- Kana iyo tafura inoratidza kuti kune chirongwa chechipatara chakakodzera uye shanduko inoshandiswa, mapoka maviri aya achakodzera. Muenzaniso: Shandura Modifier 59 neyese yechipiri, yowedzera kana yakaderera nzira yakarongwa mumutsetse 1 kana muromo 2 sezvazvakakodzera.
NCCI: Mishonga Inenge Isingaoneki Ichishandurwa
NCCI zvisingabviri kugadziriswa (MUEs) inoshandawo kune CPT uye HCPCS nhamba.
Kunyange zvazvo nzira-kusvika-nzira dzakagadzirirwa zvinodzivirira kubhadhara kwemitemo isingafananidzi pamwe chete pamutano wezvokurapa, MUE dzinodzivisa kubhadhara kwehuwandu husina kukodzera hwemauniti pane imwe nzira.
Mimwe nzira ine huwandu huwandu hwezvikwata zvinofanirwa kuziviswa kune mumwechete mushonga weMedare (anobatsiri) pazuva rimwechete rebasa nemumwe mupiki. Semuenzaniso, nhamba yekutapudza inofanira kuongororwa kamwe chete pamutsara kana icharamba.
Zvisinei, apo vanachiremba uye zvipatara vanokurudzirwa kuti vataure chete huwandu hunobvumirwa nhamba dzezvikwata zveCPT neHCPCS nhamba, dzinofanirawo kutevera mitemo yekuteerera.
- Dzivisa kusabvisa nzira. Mamwe maitiro anobatwa seanobatanidzwa. Kusunungura kubhadhara kune nzira dzakasiyana zvakasiyana-siyana dzinowanzobhadharwa semhosva imwe chete. Somuenzaniso, mvumo yekupa mvumo yekudzivirirwa kwemamwe maviri ekudzivirira kuongorora mammograms, panzvimbo yekubhadhara ku 1 mairi ekuongorora mammogram.
- Dzivisa mapcoding maitiro. Kunyoresa huwandu hwebasa kana nzira inogadzirirwa kuitira kuti uwane mari yakawanda kana kugamuchira chikwata chepamusoro chekubhadhara chinonzi kubvunzurudzwa. Kukwidziridzwa kunowanikwawo kana basa rinoitwa risati rakafukidzwa neMedare asi mabhizimisi anopa mvumo basa rinovharidzirwa panzvimbo yayo.
NCCI: Kuwedzera-On Code Edits
NCCI inowedzera-pamagadzirirwo emitemo inodzivirira kubhadhara kwekuwedzera-kodhi dzinoonekwa sechikamu chekutanga ma CPT uye HCPCS nhamba.
Mazano ekuwedzera-aya ari akabatanidzwa mumutambo wekutanga haazviparadzanisi uye haana kukodzera kubhadhara. Zvisinei, kune mamwe mazano-add-on anowedzera kune nzira yekutanga iyo inokodzera kubhadhara.
Bhuku reCPT rinozivisa uye rine mirayiridzo yakajeka yepamusoro-soro dzekuwedzera. Pamitemo iyo ine nheyo yepamusoro, code-add-on haifaniri kuonekwa sekuwedzera kwekodhi.