Create DRG Application
The G-DRG system is a learning system which, in addition to the documented service and cost data, is particularly dependent on suggestions for correcting/restructuring existing systems. In order to involve external expertise and thus 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 InEK via a DRG proposal.
Content and structure of a DRG application
The DRG applications are recorded via the InEK data portal under the menu item “DRG proposal procedure”. The proposal comprises various query points, which are divided into three groups. The query points vary depending on which of the suggestions below has been selected.
First, the master form has to be completed. The complete master data of the proposer, consisting of the name of the proposing institution/person, the data of the contact person and a selection field concerning the category of the entry, are requested at this point.
Before a solution can be formulated, the problem has to be discussed. In this field, the proposing person has enough space to describe the problem in detail.
The main objective of the DRG proposal is to describe a solution to a specific problem in order to improve/further develop the G-DRG System. In the designated field, the proposer also has enough space to describe the proposed solution.
If there is a proposal for the “further development of the service description” or “DRG system development”, the proposer has an additional tab available, which is subdivided as follows:
- DRG, to which this proposal refers
- Diagnoses related to this proposal and description of the changed use
- Procedures concerning this proposal and description of the changed use
Further relevant information can be provided to the InEK in the last tab, using electronic files (e.g. PDF).
There are various proposal options that do not differ in structure, but in the main topic.
The following proposals can be sent to the InEK via the data portal:
Proposal for additional remuneration (ZE)
Pursuant to § 17b (1) sentence 7 Hospital Financing Act (KHG):
“As far as this is necessary to supplement the flat rate, in very limited exceptional cases, the contracting parties may agree additional remunerations (ZE) for services, service complexes or medicines in accordance with § 17b (2) sentence 1.”
This means that only a few procedures are suitable for an inclusion in the DRG catalog, annexes 4 and 6 (non-priced additional fees) as well as annexes 2 and 5 (priced additional fees).
Non-priced additional fees have to be negotiated annually in their number and amount of remuneration by the hospitals and the payers. However, priced additional fees are provided with a fixed value in the DRG catalog and do not have to be negotiated separately with regard to the amount of the refund. You can see the amount of a priced additional fee here:
Proposals for the further development of the additional fees may be submitted for code changes, for the achievement of an additional fee or for inclusion of new additional fees in the DRG catalog.
Proposal for DRG system development
Porposals for DRG system development intervene in the allocation logic of a DRG. For example, the inclusion of an OPS or ICD-10 code in a DRG assignment (list under a DRG or inclusion in the Globals Functions) can be requested to ensure cost-effective mapping of the applied measure.
If the inclusion of an ICD-10 or OPS code in a DRG is requested and implemented, it is also called a triggering effect by an ICD-10 or OPS code assigned mode of action. In addition, this form is used when displacements or deletions of ICD-10 or OPS digits are to be proposed in the existing allocation logic of one or more DRGs. If the inclusion of an ICD-10 or OPS code has taken place, then this has largely influence on the assignment of a DRG in very different forms and interdependencies to other modes of action.
Proposal for the DRG system coding guidelines
Proposals for the DRG system coding guidelines may be submitted to effect changes or enhancements to the coding guidelines. Also, ambiguities can be eliminated. For example, if there is a coding guideline for a particular procedure and it is not clear whether the rule applies for the main and/or secondary diagnosis, clarification may be requested by submitting the proposal.
Proposal for the CCL matrix
Proposals for modifying the CCL matrix include, for example, the revaluation and devaluation of CCL values of individual diagnoses (ICD-10 codes) at the level of individual DRGs. 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 an application.
Proposal for calculation
Proposals for the calculation concern, among other things, the further development of the calculation manual. For example, the inclusion of a general article description (within an article group) in the annex 10 “Article list for the individual cost allocation” could be part of such an application.
All suggestions that do not fit into any of the other categories or that have cross-cutting themes fall into this category.