Medicare Secondary Payer (MSP) ke karolo ea bohlokoa ea ho fana ka litlaleho tse lokelang ho utloisisoa ka likoloto tsa bongaka. Melao e ka ba e rarahaneng. Liofisi tsa bongaka tse lefuoang ke Medicare li tlameha ho tiisa hore basebeletsi ba bona ba ikarabellang bakeng sa ho lokisetsa le ho fana ka litlaleho ba koetlisitsoe hantle le ho lula ba ntse ba hopola melao le litaelo. Nahana ka ho ea libokeng le lithuto.
MSP ke eng?
Medicare Secondary Payer kapa MSP e bua ka melemo ea Medicare ha Medicare e se eona inshorense e ka sehloohong. Medicare e hloka hore bafani bohle ba tlhokomelo ea bophelo ba tsebe ho tseba hore na Medicare ke inshorense e ka sehloohong kapa ea bobeli ho bakuli ba bona ba Medicare.
Tseba CWF
CWF kapa Common Working File ke ts'ebetso ea Medicare e bolokang boitsebiso mabapi le ho fana ka lisebelisuoa tsa bafani ba Medicare . Etsa bonnete ba hore kamehla u hlahlobe CWF e le hore u hlahlobe tlhahisoleseding ea MSP ho fumana tse ling tsa inshorense ea bophelo bo botle.
Bakuli ba Lekhetho le ka sehloohong la Medicare
Medicare ke moputso o moholo oa mokuli ea finyellang litlhoko tsena:
- 65 kapa ho feta 'me o na le moralo oa sehlopha se senyenyane oa bophelo bo botle ka mohiri oa bona oa hona joale kapa ka mohiri oa hona joale oa molekane oa hae
- 65 kapa ho feta ka inshorense ka morero oa ho tlohela mosebetsi
- Ba nang le bokooa 'me ba na le moralo oa bophelo bo botle ka sehlopha sa bona sa hona joale kapa ka mohiri oa bona oa hona joale
Bakuli ba Lekhetho la Sekondari ke mang
Medicare ke moputso oa bobeli bakeng sa mokuli ea finyellang litlhoko tsena:
- 65 kapa ho feta 'me o na le moralo o moholo oa bophelo bo botle ka mohiri oa bona oa hona joale kapa ka mohiri oa molekane oa hona joale
- Ba holofetse mme ba na le moralo o moholo oa bophelo bo botle ka mohiri oa bona oa hona joale kapa ka mohiri oa molekane oa hona joale
- E koaheloa ke Matšeliso a Basebetsi
- E koahetsoe ke inshorense ea kotsi kapa ea boikarabelo
Meriana e Etsa'ng Haeba Inshorense ea Bohlokoa e Lahla Boipiletso?
Maemong a hore inshorense e ka sehloohong e latola boipiletso, Medicare e ka 'na ea lefa feela mabaka a itseng a ho latola, joalo ka:
- Pholisi ea mongoli e felile
- Matšeliso a basebetsi a entse qeto ea hore litšebeletso ha lia koaheloa
- Inshorense ea kotsi kapa ea boikarabelo e latola kapa e nka nako e telele ho lefa. Mofani oa hao a ka 'na a fuoa tefo ea tumello haeba moemeli a lebeletsoe ho nka nako e ngata ea ho lefa.
Ho Sebelisa Boemo Melao ea FL 18-28
Khoutu 02: Boemo ke bo amanang le mosebetsi
Code 03: Mamello e Koahetsoeng ke inshorense e sa bontšoang mona
Khoutu ea 05: Khoebo e fetisitsoe
Khoutu 06: Mokuli oa ESRD likhoeling tse 30 tsa pele
Molao oa 08: Mofani oa litsebo o ne a ke ke a fana ka tlhahisoleseding mabapi le litšebeletso tsa inshorense
Khoutu ea 09: Ha u mamelle kapa molekane ha a sebelise
Khoutu ea 10: Mokuli le / kapa molekane o sebelisitsoe empa ha ho na ho fana ka litaba tsa EGHP
Molao oa 11: Bafani ba nang le bokooa empa ha ho na likhaello tsa LGHP
Molao oa 28: EGHP ea mokuli le / kapa ea molekane oa bobeli ke ea bobeli
Molao oa 29: Mofani oa batho ba nang le bokooa le / kapa LGHP ea setho sa lelapa ke ea bobeli ho Medicare
Melao 77: Mofani o amohela kapa o tlamehile / ho hlokeha ka lebaka la tumellano kapa tumellano ea tumellano ea ho amohela tefo ka moputso oa pele e le tefo e feletseng. Ha ho na tefo ea Medicare e tla etsoa.
Ho sebelisa Occurrence Melao ea FL 31-34
Khoutu ea 01: Tlhaloso ea tefo ea bongaka ea litlokotsi
Khoutu 02: Ha ho na inshorense ea molato e sebelisoang (sebelisa le nomoro ea bohlokoa 14)
Code 03: Tlokotsi - boikarabello (sebelisa le nomoro ea bohlokoa 47)
Khoutu ea 04: Likotsi - mosebetsi o amanang (sebelisa le nomoro ea bohlokoa 15)
Khoutu ea 06: Sehlōhō sa molao
Molao oa 18: Letsatsi la ho tlohela mosebetsi
Molao oa 19: Letsatsi la ho tlohela mosebetsi molekane
Molao oa 24: Letsatsi la inshorense le haneloa
Molao oa 33: Letsatsi la pele la nako ea ts'ebeliso ea bafani ba ESRD e koahetsoeng ke EGHP
Molao oa A3: Moputso Melemo e khathetse
Ho sebelisa Melao ea Bohlokoa FL 39-41
Kenya chelete ea tefo ea Payer A e fumanehang ho FL 50 bakeng sa Melao ea 12 - 43:
Melao ea 12: Ho sebetsa mofani kapa molekane ea tsofetseng
Molao oa 13: Mofani oa ESRD ka nako ea likhoeli tse 30 tsa puisano
Molao oa 14: Inshorense ea ho se molato ho kenyeletsa le koloi
Molao oa 15: Matšeliso a basebetsi
Melao ea 16: Tšebeletso ea sechaba ea bophelo bo botle kapa mokhatlo o mong oa feshene joalo ka tlhekefetso ea molao, teko ea lithethefatsi
Khoutu 41: Bofubelu bo botšo
Melao ea 42: Tsamaiso ea bo-khale
Molao oa 43: Bafani ba nang le bokooa ba ka tlase ho lilemo tse 65 le LGHP
Molao oa 44: Mofani oa chelete o lumelletse ho amohela ho lefshoa la pele ha chelete ena e le tlase ho liqoso empa e phahame ho feta tefo e fumanoeng, joale mohoebi oa sekolo sa Medicare o lokela. Kenya chelete eohle eo ue lumetseng kapa u tlamehile ho e amohela.
Molao oa 47: inshorense ea boikarabelo
Ho Sebelisa Melao ea Botsoalle FL 59
Khoutu ea 01: Molekane oa hau
Khoutu ea 04: Ntate-moholo / Nkhono
Khoutu 05: Setloholo / setloholo
Khoutu 07: Nkhono / ntate
Khoutu ea 10: Ngoana ea hlokang tlhokomelo
Khoutu ea 15: Ward
Molao oa 17: Stepson / setloholo
Molao oa 18: Boithati
Khoutu 19: Ngoana
Molao oa 20: Mosebeletsi
Molao oa 21: Ha o tsejoe
Melao ea 22: Ho itšireletsa batho ba nang le bokooa
Molao oa 23: Tšehetso e tšehetsoeng
Molao oa 24: O itšetlehile ka ba itšetlehile ka bana ba tlase
Molao oa 29: Tse ling tsa bohlokoa
Melao ea 32: 'Mè
Molao oa 33: Ntate
Code 36: Emancipated nyenyane
Molao oa 39: Mofani oa mokhatlo
Molao oa 40: Mofani oa mofani
Molao oa 41: Moemeli ea lemetseng
Molao oa 43: Ngoana moo inshorense e se nang boikarabelo ba lichelete
Khoutu 53: Molekane oa bophelo
Molao oa G8: Kamano e 'ngoe
Etela ho Medicare Claims Processing ho websaete ea cms.gov bakeng sa lenane le feletseng la litsamaiso tsohle tsa ho lefella.