Is reimbursement for event recorder implantation available on an outpatient basis?

Posted on 20.01.2022 by Abdullah Velasquez

Is reimbursement for event recorder implantation available on an outpatient basis? The background to this is that reimbursement for event recorder implantations as part of an inpatient hospital stay is increasingly being refused by health insurers if there is otherwise no medical reason for full inpatient treatment. The reason given is that such an intervention is also possible on an outpatient basis.

How is outpatient care rejected?

Since 2017, reimbursement in the context of inpatient care has been increasingly rejected because outpatient care with a cardiac monitor, due to the advancement of medical technology, is now possible and is also required for certain medical constellations.

Which patients benefit from the event recorder? Patients with a stroke whose cause is unclear, as well as patients who faint suddenly and recurrently (syncope), will benefit most from the event recorder. BVMed applied for inclusion in the EBM at the end of June 2017 to the Physicians' Evaluation Committee.

Is an outpatient implantation reimbursed? However, outpatient implantation is not yet reimbursed because an EBM figure is missing. "This leads to the situation where patients are denied the recommended treatment," BVMed said.

How does the private patient get the reimbursable bill back? The private patient thus first pays his bill directly to the doctor, dentist or psychotherapist and then receives the reimbursable portion back from his private provider.

What reimbursement options are available for outpatient and inpatient services?

Two model variants have been developed for the reimbursement of outpatient and ambulatory services on the basis of a common model framework. In both, a separate reimbursement area is installed for medical services provided by outpatient and inpatient service providers.

Are outpatient and inpatient care separate? In Germany, outpatient and inpatient care are strictly separated. For outpatient service provision in hospitals, there are strict rules in social and contract physician law. Hospitals are free to decide on the deployment of their staff in inpatient care.

What services are delegated in outpatient care? In outpatient care, on the other hand, a service cannot easily be delegated or provided in its entirety by an agent. The principle of personal provision of services applies. On the one hand, this results from the treatment contract.

What are outpatient services? Outpatient services are provided by "services" (see § 75, I SGB XII) and take place in the beneficiary's own household. As a rule, outpatient services require a contractually regulated separation of care, provision and accommodation.

What applies to emergency outpatient care provided by hospitals?

Emergency outpatient treatment by hospitals is considered a contractual medical service if no contractual physician is available to treat the patient immediately. The emergency outpatient medical service is intended for patients who urgently need a doctor outside regular consultation hours due to acute illnesses.

Is differentiation appropriate for emergency hospital care? In this respect, the differentiation made by the BSG may well be convincing for emergency treatment in the hospital as part of normal outpatient primary care. However, the differentiation is not suitable for complex emergency treatments that can only be provided in the specific care system of a hospital.

How are treatment services categorized for emergency outpatient care? To further examine the importance of hospitals for outpatient emergency care, the treatment services of hospitals are categorized according to "general emergency treatment," "special emergency treatment," and "hospital-specific emergency treatment."

What is emergency outpatient treatment? Outpatient emergency treatment is generally a service provided by SHI-accredited physicians, but patients can also use hospitals. The hospital bills the Association of Statutory Health Insurance Physicians for the services provided on the basis of the standard evaluation scale.

How do they get reimbursable costs through health insurance?

After verification by the health insurance company, you will receive the reimbursable costs transferred by the health insurance company. You then submit the confirmation of advance payment from the statutory health insurance fund to the supplementary insurance company. The insurance company will reimburse the remaining costs up to 100 percent depending on the agreed tariff.

What services can health insurance companies reimburse?

Reimbursements and co-payments: You can still take advantage of certain services that go beyond the standard offer in special tariffs. The health insurers then reimburse part of the treatment or make co-payments. Bonus programs and optional tariffs : Bonus programs offer insured persons incentives for a healthy lifestyle.

What is the remuneration of outpatient and ambulatory services in Germany?

The remuneration of outpatient and ambulatory services in Germany is often fragmented along the different service provider groups, but also the insured status of the patients. The aim of the study was a critical analysis of the existing reimbursement systems and their incentive effects.

What is the remuneration of medical services? Uwe Schwenk Program Director "Improving Care - Informing Patients" Bertelsmann Stiftung The reimbursement of physicians' services is a central management tool for health care, but it is less intensively discussed by the general public than the structure of the revenue base.

How recognizable is outpatient care between sectors?

Coordination of this outpatient "specialty care" between the sectors is not yet apparent. This is particularly evident in the lack of consideration given to the outpatient activities of hospitals in the planning of demand for SHI-accredited physicians.

How should outpatient care be structured? In the future, outpatient care should be divided into the three sectors of primary, specialist and specialty care. However, cross-sectoral demand planning is only one aspect of the fundamental problem in dealing with outpatient hospital services.

How can outpatient care be eliminated?

The clear separation of the two areas of care can be eliminated by cross-sectoral care under certain conditions. Examples of this are outpatient operations, which can be performed both by physicians in private practices and by employed physicians in hospitals.

How do I get reimbursed for bills when I visit a doctor?

As a rule, a private patient must pay all the bills incurred during a visit to the doctor himself and is then reimbursed in full by the private health insurance company, depending on the tariff.

How is the doctor's bill sent directly to the health insurance company?

In the case of statutory health insurance, the doctor's bill is sent directly to the relevant health insurance fund.

When will the patient receive a bill from the insurance company?

This means that after treatment, the patient receives an invoice directly from the doctor, which must be paid within a reasonable period of time. This period is sufficient to get the bill reimbursed by the insurance company without having to pay in advance.

How are medical bills billed?

the settlement of medical bills. As already mentioned, medical expenses must always be substantiated by invoices (receipts). For you as a civil servant, the procedure is such that you are treated as a private patient and have an invoice issued by the attending physician, which must also be paid privately.

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