Ukulwa ubuqhetseba njengenxalenye yoMthetho wamaBango obuXoki, urhulumente uya ejonga ngakumbi kumgaqo weyure ezingama-72 kunye neMedicare. Lo mthetho unokuba yintloko kubaphathi bezibhedlele kuba kulula ukwaphula imigaqo ngengozi xa kungeniswa imali eyimbuyekezo.
Umgaqo weyure ezingama-72 kunye neMedicare
Umgaqo weyure ezingama-72 uyinxalenye yeNkqubo yokuHlawula yokuFunyanwa kweMedicare (PPS). Umgaqo uthi naziphi na izigulana ezingalaliswayo okanye ezinye iinkonzo zonyango ezenziweyo kwisithuba seeyure ezingama-72 phambi kokuba zamkelwe esibhedlele kufuneka zibotshwe zibe ziibhili. Enye indlela yokuthetha ngomgaqo kukuba iinkonzo zonyango ezingalaliswayo ezenziwa ngaphakathi kweeyure ezingama-72 zeenkonzo zesigulana ziqwalaselwa njengebango elinye kwaye kufuneka zihlawulwe kunye endaweni yokuzahlula.
Amanqaku afanelekileyo- Unyango lweeMithi ezi-8
- Unyango
- Ukubhengeza iBango leMedicare
Imizekelo yeenkonzo zokuqonda isifo ezigutyungelweyo kuMgaqo weyure ezingama-72 zibandakanya:
- Umsebenzi welebhu
- Radiology
- Iyeza lenyukliya
- Ukuskena kweCT
- Ukubulawa
- Yentliziyo
- Iinkonzo ze-Osteopathic
- ECG
- BONA
Iinkonzo zokuNxibelelana ezingahambelaniyo zibandakanyiwe
Enye yezona zinto zididayo kumgaqo weyure ezingama-72 kukuba iinkonzo zonyango ezingadibaniyo zinokubotshwa ngonyango olungalaliswanga.
Umzekelo, masithi isigulana siya kwiziko lezonyango esibhedlele kwaye kwenziwe i-x-ray emlenzeni wakhe. Uye waziva iintlungu emlenzeni kwaye kufuneka ahlolwe. Oku kubonakala ngathi kuya kuhlawulwa ngokwakho, ngokwahlukileyo kuwo nawuphi na amanye amabango. Nangona kunjalo, ukuba isigulana esinye sihlola esibhedlele kwisithuba seeyure ezingama-72 kutyando olwalucwangcisiwe lwangaphambi kokunyangwa, emva koko umlenze we-x-reyi uhlawuliswa kunye notyando. Utyando akufuneki nokuba lubekhona emlenzeni wakhe. Ingaba yinkqubo engahambelani ngokupheleleyo, njengokuhlinzwa kwentliziyo. Inxalenye ebalulekileyo kule meko kukuba i-x-ray yayiyinkonzo yokuqonda isifo.
Ezinye iinkonzo azinakukhutshwa
Umahluko phakathi 'kweenkonzo zokuqonda isifo' kunye 'nezinye iinkonzo' ngundoqo ekuqondeni ukuba lisebenza njani iiyure ezingama-72 kunye neMedicare. Makhe sijonge kwelinye icala ukubona umahluko phakathi kwezi zimbini. Isigulana esinye njengasentla, emva kokufumanisa ukuba sinesifo samathambo emlenzeni waso, sibuya ngosuku olulandelayo kwiziko lezonyango leseshoni yonyango. Kuba unyango lomzimba emlenzeni aluhambelani notyando lwentliziyo olucwangcisiweyo, unyango lwasemzimbeni lunokuhlawulwa ngokwahlukeneyo kuqhaqho lwentliziyo.
Kukho okwahlukileyo kulo mthetho, nangona kunjalo. Ukuba unyango lomzimba luhambelana notyando analo ngaphakathi kweeyure ezingama-72, unyango lwasemzimbeni luxhomekeke kutyando lwangaphakathi kuba banxulumene. Sisebenzisa isigulana esinye njengomzekelo, unyango lwaluya kuxhonywa xa enokuthi enze utyando emlenzeni olungxamisekileyo okoko unyango lwenziwe emlenzeni owawusenziwa kuwo.
Ukugcina irekhodi
Ukuqinisekisa ukuba amatyala ayacutshungulwa (kwaye ahlawulwe) ngokufanelekileyo, isibhedlele kufuneka sigcine iirekhodi ezifanelekileyo. Oku kunjalo ukuze i-Medicare ikwazi ukwahlula isigulana ngasinye kwiQela eliDibeneyo lokuDibanisa (i-DRG). Ibhili nganye yonyango kufuneka ibandakanye olu lwazi lulandelayo ukuhlangabezana neemfuno:
- Ukuchongwa kwesona sifo (esona sizathu siphambili sokungeniswa esibhedlele)
- Iingxaki kunye neComorbidities (isifo sesibini)
- Iinkqubo ezenziweyo
- Ubudala besigulana
- Isini
- Ukukhutshwa kokuziphatha (ngaba yayiqhelekile okanye isigulana sidlulisiwe, njalo njalo?)
Ukuhlala uthobela
Njengoko ubona, kulula kakhulu ukwenza impazamo kwi-Medicare ephindwe kabini. Ukuba isibhedlele sibanjwe sisenza oku, baya kuhlawuliswa kakhulu. Ukunceda uhlale uthobela umthetho, ezinye izibhedlele zijikela kwiindlela zophicotho-zincwadi ezincedisayo zekhompyuter (ii-CAATs) ukunceda ukubona iindawo ezahlukeneyo zamatyala ekufuneka enziwe ziinyanda.
