Ko te awhina mo te wa kaore he kaiwhakarato-kaiwhakarato raatau tata ranei
Ko tetahi waahanga whatunga whatunga ko tetahi kamupene inihua hauora taputapu e whakamahia ana hei utu mo nga waahi i roto i ta raatau whatunga ratonga hauora kirimana. I te wa ka whakawhiwhia koe e te kaitohu hauora i te wehenga whatunga whatunga, e mohiotia ana ano he rereke haumanu, he mea tuku koe ki te whiwhi hauora mai i te kaiwhakarato o waho i te whatunga i te utu i nga utu whakawhiti utu- utu.
He aha te Whakawhiti Whatunga Whatunga
Kaore he awhina i te whatunga whatunga, ka kite koe i te kaiwhakarato-waho-whatunga, ka utu atu koe i te utu kua utua e koe ki te mea kua whakamahia e koe he kaiwhakarato-whatunga. Mena he HMO koe , he EPO ranei , kaore e utua e to mahere hauora tetahi o nga utu o to ratonga whatunga i waho atu i te mea kei te whiwhi koe i te wehenga whatunga whatunga. Mena he mahere PPO , POS ranei, ka awhina to mahere mahere ki a koe ki te utu mo te atawhai e puta ana koe ki waho-o-whatunga. Heoi, ka nui ake te tangohanga , te tahua, me nga taapiri ki te whakamahi i te kaiwhakarato-waho-whatunga i te wa e whakamahi ana koe i te kaiwhakarato-whatunga.
Ko te tono mo te wehenga whatunga mai i to kaiwhaiwhai hauora ka tono tono ki te kaipupuri mo te tiaki i te atawhai kei a koe mai i te kaiwhakarato i waho i te whatunga . Mena ka whakawhiwhia e te kaitohutohu i te waahanga whatunga whatunga, ka utua e koe te utu whakawhiti, te utu, te waahi ranei i raro i te whatunga.
He aha e taea ai e te Whakaaturanga Whatunga Whatunga te Āwhina
Tuatahi, kia mohio ko te mahere hauora e kore e hiahia ki te tuku i tetahi tuunga whatunga whatunga. He mahi ano hoki mo ratou, a ka mutu pea he utu mo ratou. Heoi, mehemea kaore i te mahere hauora tetahi kaiwhakarato-whatunga kei roto i to rohe, mehemea kaore e taea e te kaiwhakarato te whakarato i te ratonga hauora e hiahia ana koe, ehara i te mea tika kia utua e koe te utu utu nui ake na te mea ko te Ko te mahere hauora kaore he ratonga kaiwhakarato e tino kaha ana.
Na, ka taea e nga kaitautoko te tuku i tetahi waahi whatunga whatunga hei tuku ia koe ki te whiwhi i nga tiaki e hiahiatia ana e koe mai i tetahi kaiwhakarato o waho-kore kaore e utua ana atu i te mea ka utua e koe.
He take ka taea e koe te Whakaritea i te Whakaaetanga Whakawhiti Whatunga
Kaore pea koe e whakaaetia he tuunga whatunga whatunga kaore e whai ake nei nga korero e whai ake nei:
- Ko te tiaki e tono ana koe he painga e pa ana, me te mate hauora .
- Kaore he kaiwhakarato whatunga ka taea te whakarato i te ratonga e hiahiatia ana e koe i roto i te tawhiti tika. Ka whakamaherehia e te mahere hauora he aha te tawhiti tawhiti. I etahi mahere hauora, pea pea 50 maero. I etahi atu, ka nui pea te tawhiti.
Mena kei te pai to paanga ki nga whakaritenga o runga ake nei, kua kitea e koe he kaiwhakarato-waho-whatunga e tutuki ana i nga mea katoa e hiahiatia ana e koe, me tuku atu he tono ki to kamupene inihua hauora mo te wehenga whatunga whatunga. I etahi wa, ka pai te kaiwhakarato ki waho i te whatunga ki a koe; i etahi atu take, me mahi koe ia koe ano.
Me ui koe mo te rererangi whatunga whatunga ki mua i te whiwhi tiaki . Mena ka tatari koe kia tae noa ki muri i to raatau tiaki, ka tukatukahia e te mahere hauora te kerēme i waho i te whatunga me te utu atu.
Ko te Whakaaetanga Whakawhiti Whatunga anake Kei te Kotahi Te Ratonga Whaiaro
Kaore e whakaaetia e te kape whatunga whatunga ki a koe te mahere pepa hei kite i te kaiwhakarato-waho-whatunga mo nga ratonga e hiahia ana koe, i nga wa katoa e hiahia ana koe.
Engari, ka tukuna e te kaitohutohu he wehewehe whatunga, ko te tuhi anake e hipokina ana i tetahi ratonga motuhake e whakaratohia ana e tetahi kaiwhakarato i waho atu o te whatunga i roto i te waahi iti.
He aha e hiahia ana koe mo to tono Tono
Ko nga korero e hiahiatia ana e koe i te wa e tono ana koe ki te wehenga whatunga whatunga:
- Ko te CPT me te HCPCS e whakaatu ana i te ratonga hauora, i te tukanga ranei e hiahia ana koe.
- Ko te waehere ICD-10 e whakaatu ana i to taakotanga.
- Ko nga korero whakapiri a te kaiwhakarato o waho.
- He rarangi ra kei te tumanako koe ki te whiwhi i te ratonga tono. Hei tauira, mai i te Hui-tanguru 1, 2018, ki te 31 o Hurae, 2018.
- Ko nga ingoa o tetahi kaiwhakarato-whatunga o te motuhake motuhake i roto i to rohe rohe me te whakamarama mo te aha e kore e taea e te kaiwhakarato rorohiko ki te mahi i te ratonga.
Kia mohio kei te whakauruhia nga ratonga e hiahiatia ana e koe, me tango nga ture CPT, waehere HCPCS, me nga ICD-10 mai i to kaiwhakarato o-waho. Mena he uaua tenei no te mea kaore i uru tonu koe ki taua kaiwhakarato, ka taea pea e te rata e kii atu ana ki a koe nga ture hauora e hiahiatia ana.
Ko te whakamarama i te aha e kore ai e Tautuhihia e Tuku Kaihoko I-Whatunga
Mena he kaiwhakarato-whatunga kei roto i te ratonga motuhake ano he kaiwhakarato i waho i te whatunga ka tonohia e koe he rererangi whatunga whatunga, ka hiahia koe ki te whakamarama ki to kamupene inihua hauora kaore koe e taea te whakamahi i te-whatunga kaiwhakarato.
Anei he tauira. Me ki atu e hiahia ana koe ki te taatai taringa me te tono kia kore he rererangi whatunga whatunga hei hipoki i te kaitautoko-waho-whatunga-ahumahi e mahi ana i te mahi. Engari, kei roto i te takiwa matawhenua tetahi ahumahi-whakawhitinga whakawhitinga rorohiko. Kua koroheke te pouaka whakawhitiwhiti-rorohiko, he kaha te ringa, a kaore i te mahi i te waa. Mena kaore koe i te kaha ki te whakamarama i to mahere hauora he aha te take kaore e taea e te kaitaunuirongo-rorohiko te whakarato i te ratonga e hiahia ana koe, kaore pea e whakaaetia to tono.
He aha te mahi Mehemea ka Katihia to Tono
Kaua e whakaroa noa ki te whakakorehia to tono. Karangatia to kamupene inihua hauora kia kitea he aha. I etahi wa ka whakakahorehia nga tono mo tetahi take poto penei:
- Kaore i taea e te kaiwhakahaere te whakapiri atu ki te tari o te kaiwhakarato o waho.
- E whakaaro ana te kaihuihau kei roto i nga kaiwhakarato whatunga ka taea te whakarato i taua ratonga.
- Kaore te kaipupuri i a koe i to taipitopito tika, na reira ka whakaaro koe kei te tata koe ki nga kaiwhakarato-whatunga kaore koe e mahi.
Ka taea te whakakore i enei hapa katoa. Ina mohio koe he aha i whakakahoretia ai te tono, ka taea e koe te tono i taua whakatau, te tuku ranei i tetahi tono hou e whakauru ana i nga korero hei whakapiki i to tono.