G-DRG proposal
Creation
G-DRG proposal procedure
Content and structure of a G-DRG proposal
The G-DRG system is a learning system that relies not only on documented service and cost data, but also on suggestions for correcting or restructuring existing systems. In order to involve external expertise and thus to further develop the system in the best possible way, it is possible to send a well-founded description of the problem together with a proposed solution to the Institute of the Hospital Remuneration System (InEK) via a DRG proposal.
DRG proposals are entered via the InEK data portal under the menu item DRG proposal procedure. This comprises various query points, which are divided into three groups. They vary depending on which proposal category is selected.
Master form
First, the master form must be filled out. At this point, the complete master data of the proposer is requested, consisting of the name of the proposing institution/person, the data of the contact person and a selection field regarding the category of the entry.
Problem
Before a proposed solution can be formulated, the problem must first be discussed. In this field, there is enough space for the person proposing the solution to describe the problem in detail.
Proposed solution
The core objective of the DRG proposal is to describe a solution to a specific problem in order to improve/develop the G-DRG system in this respect. In the field provided for this purpose, the proposer also has enough space to describe the proposed solution.
(Codes)
If there is a proposal for further development of the service name or G-DRG system development, an additional tab is available to the person making the proposal. It is subdivided as follows:
- DRG to which this proposal applies
- Diagnoses to which this proposal relates and description of the changed usage
- Procedures to which this proposal relates and description of the changed usage
Additional relevant information can be provided to InEK in electronic form in the last tab.
In order to provide the InEK with as complete a picture of the “problem” as possible, the proposing institutions or individuals are asked to provide as detailed information as possible. For this purpose, the proposal creator can make use of the query points that are to be submitted in the NUB inquiry procedure.
Proposal categories
Proposal for system development DRG
DRG system development proposals intervene in the assignment logics of a DRG. For example, the inclusion of an OPS or ICD code in a DRG assignment (list under a DRG or inclusion in the global functions) can be requested here in order to ensure cost-appropriate mapping of the applied measure.
When the inclusion of an ICD-10 or OPS in a DRG is requested and implemented, it is also referred to as a triggering effect by an OPS or ICD-10 code assigned mechanism of action. In addition, one uses this form when shifts or deletions of OPS or ICD-10 codes are to be proposed in the existing assignment logics of one or more DRGs. Once an OPS or ICD-10 code has been included, it influences the assignment of a DRG, for the most part in very different ways and interdependencies with other mechanisms of action.
Proposal for additional fee
Pursuant to § 17b (1) sentence 7 Hospital Financing Act (KHG):
“To the extent necessary to supplement the fee per case in narrowly defined exceptional cases, the contracting parties may agree on additional fees for services, service complexes or drugs in accordance with paragraph 2, sentence 1.”
This means that only a few procedures are suitable for inclusion in the fee per case catalog, Annex 4 and 6 (unpriced additional fees) and Annex 2 and 5 (priced additional fees).
The number and amount of unpriced additional fees must be negotiated annually by the hospitals with the payers. Priced additional fees, on the other hand, have a fixed value in the fee per case catalog and do not have to be negotiated separately with regard to the reimbursement level. You can view the amount of a priced additional fee here.
Proposals for the further development of additional fees can be submitted for code changes, the achievement of an additional fee or the inclusion of new additional fees in the catalog.
Proposal for CCL Matrix
Proposals to change the CCL matrix relate, for example, to the revaluation or devaluation of CCL values of individual diagnoses (ICD codes) at the level of individual DRGs. New additions or deletions of diagnoses as CC in all DRGs, formula changes or adjustments to the exclusions of individual diagnoses can also be part of such a proposal.
Proposal for the coding guidelines for the DRG system
Proposals regarding the coding guidelines for the DRG system can be submitted to effect changes or extensions to the coding guidelines. This can also be used to resolve ambiguities. For example, if a coding guideline exists for a particular procedure and it is not apparent whether the rule applies to principal and/or secondary diagnoses, clarification can be requested by submitting the proposal.
Proposal for calculation
Suggestions regarding costing concern, among other things, the further development of the costing manual. For example, the inclusion of a general article description (within an article group) in Annex 10: Article list for direct cost allocation, could be part of such a proposal.
Other proposals
This section includes all those proposals that do not fit into any of the other sections or involve cross-cutting issues.