Outpatient Reimbursement

 

Regulations for outpatient billing in hospitals

All catalogs in one place and interactively linked to each other

to the AOP catalog
to the EBM catalog
to the Hybrid-DRG catalog

Functions of the ‘Outpatient Catalogs’ sections

The catalogs that map outpatient service provision consist of the AOP catalog, the EBM catalog and the hybrid DRG catalog. Information is added to each individual service to simplify billing and provide a quick overview. For example, the contextual factors that enable service provision and secure billing in an inpatient setting are displayed. A direct connection to the grouper shows the billable Hybrid-DRG or GOP numbers from the EBM catalog.

AOP catalog

  • Insight into the AOP catalog incl. context factors
  • Direct connection to the EBM catalog

Hybrid-DRG catalog

  • Revenues from Hybrid-DRG
  • Nursing revenue valuation ratio

EBM catalog

  • Billing information and reimbursement
  • Connection to related GOP Codes

Link to § 21 data sets

  • Analysis of hospital-specific outpatientization
  • Risks and opportunities for hospital planning

Are you familiar with the new groupers?

1. The Context grouper: Admit as an inpatient or operate as an outpatient? Check the service for reference to the AOP or hybrid DRG catalog and for possible context factors.

2. The EBM grouper: Which GOPs bill for outpatient cases? If the case has no context factors, the EBM grouper will give you all billable EBM (GOPs)!

 

Learn more about the Context Grouper Learn more about the EBM Grouper

General platform functions

  • Historical display of data since 2006 (trend graphs)
  • Numerous filter parameters tailored to specific areas
  • Display of results in various graphs
  • Link to all platform areas
  • incl. export function in all areas
  • Available in German and English
  • Integrated video learning platform for all areas
  • Support from experts at the Reimbursement Institute

Source

The information presented here is based on information from the official regulations of the National Association of Statutory Health Insurance Physicians (KBV) and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) in cooperation with the German Hospital Federation e.V. (DKG). Information from the Federal Ministry of Health (BMG) and the Institute for the Hospital Remuneration System (InEK) was also used.

In detail, these sources were used:

  • BMG and InEK – Hybrid-DRG catalog
  • DKG and GKV – AOP catalog
  • KBV – EBM catalog