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 mapping outpatient services combine the AOP catalog, the EBM catalog, and the Hybrid DRG catalog. Detailed information is added to each individual service to simplify billing and provide a quick overview. For instance, contextual factors that enable service provision and secure billing in an inpatient setting are displayed. A direct connection to the groupers shows the billable Hybrid DRG or GOP numbers from the EBM catalog.

AOP catalog

  • Insights into the AOP catalog, including contextual factors

  • Direct connection to the EBM catalog

Hybrid-DRG catalog

  • Revenues from Hybrid-DRG
  • Nursing revenue valuation ratios

EBM catalog

  • Billing information and reimbursement rates
  • Direct link to related GOP codes

Link to § 21 data sets

  • Analysis of hospital-specific outpatient care transition
  • Risks and opportunities for hospital planning

Discover our Case Navigator yet?

 

The Case Navigator uses the services to be provided to determine whether a case can be admitted as an inpatient or whether it relates to the AOP or Hybrid DRG catalogue. It also checks for any contextual factors, outputs MBEGs and is directly linked to the groupers.

 

Learn more about Case-Navigator

Discover our EBM-Grouper yet

 

The EBM Grouper uses the OPS codes to show you which GOPs can be billed. All billable codes relating to the service – such as additional services, surcharges or flat-rate fees – are displayed with the amount in euros. Simultaneous procedures are also calculated precisely.

 

Learn more about  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