Medicare uye makambani akawanda ehutano inshuwarhu anobhadhara zvipatara achishandisa DRGs, kana kuti kuongororwa kunobatanidza boka . Izvi zvinoreva kuti chipatara chinobhadharwa zvichienderana nehutano hwechirwere chinogamuchirwa panzvimbo pekutsvaga izvo zvakashandiswa chaizvo kuchengeta murwere wepachipatara.
Kana chipatara chinogona kurapa murwere pachinenge chichishandisa mari shoma kudarika kubhadhara kweDGG nokuda kwechirwere ichi, chipatara chinopa purofiti.
Kana, apo uchirapa murwere wepachipatara, chipatara chinotora mari yakawanda kudarika kubhadhara kweDGG, chipatara chicharasikirwa nemari pachipatara ichi. Izvi zvinoreva kutarisira mari yekuchengetedza hutano nekukurudzira kushanda zvakanaka kwezvipatara varwere.
Chikonzero Nei Waifanira Kuziva?
Kana iwe uri murwere, kunzwisisa nheyo dzezvinhu zvipi zvinokanganisa basa rako reDGG rinogona kukubatsira kuti unzwisise zviri nani chipatara chako, iyo yekambani yehutano yehutano kana Medicare iri kubhadhara, kana kuti nei wakagoverwa imwe DRG.
Kana iwe uri chiremba panzvimbo pane murwere, kunzwisisa nhungamiro yekupa DRG kunogona kukubatsira kuti unzwisise kuti zvinyorwa zvako mune rerapi yezvechiremba zvinokonzera sei DRG uye kuti Medicare ichadzorera chii kune chirwere chechipatara chakapiwa. Ichakubatsirawo kuti unzwisise kuti nei mabodhi uye vateereri vekuteerera vanokubvunza mibvunzo yavanokumbira.
Matanho ekutsvaga DRG
Iyi inongororwa yakajeka yematanho ezvinyorwa zvinoshandiswa muchipatara izvo zvinoshandiswa kugadzirisa DRG yevarwere vechipatara. Iyi haisi iyo iyo iyo coder inozviita sei; munyika chaiyo, coders ine ruzhinji rubatsiro kubva kune software.
- Sarudza kutsvaga kukuru kwekugamuchira kwechiremba.
- Sarudza kuti kana kwete here pane chirongwa chokuvhiya.
- Sarudza kana paine chero chinhu chakakosha mumamiriro ezvinhu kana zvinetso. A comorbid condition ndeimwe dambudziko rezvehutano rinoitika panguva imwechete sechinetso chekurapa chikuru. Inogona kunge iri dambudziko rakabatana, kana zvachose kusagadzikana.
An Example
Ngatitii vakwegura Mai Gomez vanouya kuchipatara nemutsipa wevakadzi mushure, unozivikanwa kazhinji sechinhu chakaputsika . Anoda kuvhiyiwa uye anotarirwa kushandiswa kwechiuno . Paanenge achirapa kubva pakuvhiyiwa kwake kwechiuno, dambudziko rake risingagumi rinopera uye anowedzera systolic congestive mwoyo kusakundikana . Pakupedzisira, vanachiremba varo vanowana Mai Gomez's kushungurudzika kwomwoyo pasi pesimba, iye achiporesa zvakanaka, uye akabudiswa kune imwe nzvimbo yekurapa yepachipatara yekurapa kwakasimba muviri asati adzokera kumba.
Mrs. Gomez's diagnostic guru inenge iri kuputsika kwemutsipa wevakadzi. Basa rake rokuvhiya rinobatana nechekudzidzira kwake kukuru uye inoshandiswa zvachose yekudzoka. Uyezve, ane chirwere chikuru chinokanganisa: acous systolic congestive heart failure.
Apo coder inodhura zvose izvi ruzivo mu-software, software ichaparadzira DRG ye 469, ine musoro unoti "Major Joint Replacement kana Kuiswazve Kwekudzika Kwakawanda ne MCC."
Zvimwe Pamusoro Pechikamu chekutanga: Kuongorora Kukuru
Chikamu chakakosha chekugovera DGG ndiko kuwana maitiro akakodzera kuongororwa. Izvi zvinoratidzika sezviri nyore asi zvinogona kuva zvakasimba, kunyanya kana murwere ane zvinetso zvakasiyana-siyana zvehutano zvichiitika panguva imwe chete. Maererano neCMS , "Kuongorora kukuru ndiwo mamiriro akaiswa mushure mekudzidza kuti ave mukuru wekutambira."
Kuongorora kukuru kunofanira kuva dambudziko raivepo pawakabvumirwa kuenda kuchipatara; haikwanisi kuva chimwe chinhu chakagadzirwa mushure mokunge iwe wabvumirwa. Izvi zvinogona kunge zvakanyangadza sezvo dzimwe nguva chiremba wako asingazivi chii chakakanganisika newe apo iwe unobvumirwa kupinda kuchipatara.
Somuenzaniso, zvichida iwe unobvumirwa kuenda kuchipatara nemarwadzo emimba, asi chiremba haazive chinokonzera marwadzo. Zvinomutora nguva yakati kuti aone kuti iwe une kenza yekoloni uye kuti kenza yekoloni ndiyo inokonzera marwadzo ako. Sezvo chirwere chekoloni chaivapo pakugamuchirwa, kunyange zvazvo chiremba aisingazivi chinokonzera marwadzo pawakabvumirwa, kenza yekoloni inogona kugoverwa semukuru wako kuongororwa.
Zvimwe Pamusoro Pechipiri 2: Nzira Yokuvhiya
Kunyangwe izvi zvichiita sezvakaoma uye zvakaoma, kufanana nezvimwe zvinhu nezvehutano inshuwarisi uye Medicare, hazvisi. Kune mitemo miviri inotarisa kana uye nzira yekuvhiya inokanganisa sei DRG.
Kutanga, Medicare inotsanangura zvinorehwa senzira yekuvhiya nokuda kwekupa DGG, uye chii chisingaverengi sekuvhiya. Zvimwe zvinhu zvinoratidzika sokugadzira chirwere kumurwere ane chirongwa hazvirevi sekuvhiya kana iwe uchipa DRG yako.
Chechipiri, zvakakosha kuzive kana chirongwa chinoshandiswa mubvunzo chiri muchikamu chikuru chekuongororwa senyaya yekuongorora kukuru. Zvose zvinonyanya kufungidzirwa chikamu chikuru chekutsvaga, chinenge chakavakirwa pamitambo yemuviri. Kana Medicare ichiona nzira yako yekuvhiya iri mukati mechikamu chikuru chekuongorora chirwere chako chinonyanya kuongororwa, yako DRG ichave yakasiyana pane iyo Medicare inofunga kuti chirongwa chako chekuvhiya chisingaenderani nekutarisa kwako kukuru. Mumuenzaniso uri pamusoro apa naVaMess Gomez, Medicare inofunga kuti chirwere chinoshandiswa pakugadziriswa uye hip inoputsika kuva mune imwechete yakakura yekuongorora.
Zvimwe Pamusoro Pechikamu chechitatu: Comorbid Mamiriro uye Matambudziko
Sezvo inoshandisa mamwe masimba uye zvichida inodhura zvakawanda kutarisira murwere akaita saMe Gomez uyo ane zvose zvakaputsika zvakaputika uye zvakanyanya kupesana mwoyo kusakundikana pane zvinotarisirwa kutarisira murwere ane chiuno chakakoromoka uye pasina zvimwe zvinetso, vazhinji veDGG vanotora izvi kufunga. Medicare inotosiyanisa pakati pemamiriro makuru emakirbidhi akadai sekupererwa kwepfungwa kusagadzikana kwemoyo kana sepsis, uye kwete-so-makuru-makuru-comorbid mamiriro akaita seanonyanya kutyisa kweHCOPD asingagumi nokuti mamiriro makuru ekugadzirisa anoda humwe hupfumi hwekurapa pane zvisiri izvo-izvo-zvikuru . Mumamiriro ezvinhu akadai, panogona kunge kune maDGG matatu akasiyana, anozivikanwa seRDG triplet:
- DRG inobhadhara mubhadharo kwekudzidzira kukuru kusina chero mamiriro ezvinhu anonyadzisa kana zvinetso.
- DHC inobhadhara-kati-miviri yekuongorora kwekukurukurirana ne-kwete-so-major comorbid mamiriro. Izvi zvinozivikanwa seDDRG neCC kana c omorbid c ondition.
- DHR yakabhadhara zvakanyanya nokuda kwekutsvaga kukuru uye yakakura comorbid chimiro, inozivikanwa seDDRG ine MCC kana m ajor c omorbid c ondition.
Kana iwe uri chiremba uchibvunza mibvunzo kubva kune coder kana dhipatimendi rekuteerera, mazhinji emibvunzo iyi ichava nechinangwa chekutarisisa kana murwere ari kurapwa kweCC kana MCC panguva yaanogara muchipatara kunze kwekutarisirwa kumukuru kuongorora.
Kana iwe uri murwere achitarisa chikwereti chako kana tsananguro yezvibatsiro uye kambani yehutano inshuwarheni inokweretesa zvirwere zvichienderana neDGG yokubhadhara, iwe uchaona izvi zvichiratidzwa mune musoro weDGG wawakapiwa. Musoro weDGG unosanganisira "MCC" kana kuti "neCC" zvinoreva kuti, kunze kwekurapa chiziviso chikuru chawakagamuchirwa, chipatara chakashandisawo zvigaro zvekurapa comorbid chiitiko paunenge uchipatara.