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Remuneration Hospital

German hospitals are remunerated with a lump sum per case. These are settled by means of the hospital law and other agreements. Psychiatric hospitals are billed with the PEPP daily rates based on the Federal Act on Fees.

German DRG-catalog 2017 (inpatient, german hospital) drg_katalog_2017_160923

German PEPP-catalog 2017 (Inpatient, psychiatric hospital) pepp-catalog_2017

The Hospital Financing Reform Act (KHRG) of March 2009 gave the GKV-Spitzenverband, the Association of Private Health Insurance and the German Hospital Society the task of developing a lump sum system on the basis of daily allowances. Until then, the hospital services in psychiatry and psychosomatics have mostly been paid with day-to-day care. The Institute for the Remuneration System in the Hospital (InEK) developed a system for "flat-rate charges for psychiatry and psychosomatics" (PEPP), which forms the technical basis for the introduction of a fixed-price system for psychiatry in the Psych-Pay Act of 21 July 2012.

By 2016 budget neutral phase with gradual conversion to the new system, from 2017 binding for all hospitals. By 2021 gradually convergence to national prices





New Treatment methods

In the stationary sector, "permission with prohibition of reservation" applies in general. This means that all medical devices or procedures which have a CE certificate and which the Federal Joint Committee has not explicitly excluded from the care can be used in hospitals. However, the application of new methods of examination and treatment (NUB) can be more expensive than that of the medical products or methods used so far. The financing of the NUB by the cost carriers is then possibly not sufficient. For these NUBs, which can not yet be properly remunerated by way of lump sums and additional charges, the hospitals may negotiate temporary, case-related charges or special charges with the cost-bearers pursuant to the KIEntgG (KHEntgG) §6 Paragraph 2. The prerequisite is that the Institute for the Remuneration System in the Hospital (InEK) has previously certified the NUB status to the procedure. For this, the procedure has to be demonstrable new and the procedure has not yet been mapped in the DRG system. If this is not the case, a NUB application should be omitted.

EXCLUSIONS: New methods of examination and Treatment 2016 (inpatient, german hospital) hospitals

EXCLUSIONS: New methods of examination and Treatment 2016 (outpatient, german physicans) physicans

INCLUSIONS: New methods of examination and Treatment 2016 (Level 1, inpatient, german Hospital) NuB Level 1 2016

Country Base Rates (inpatient)

(inpatient) LBF 2016

Each case lump has a relative weight that is multiplied by the base value of the country (simplified representation).

The country baseline case value is used in the context of hospital financing to calculate the costs that health insurance funds reimburse to hospitals for inpatient services. It is agreed annually by the health insurance companies and hospital companies at land level. In particular, the foreseeable general cost development, profitability reserves and changes in performance are taken into account. Since January 1, 2010, the basic state-of-case has been the sole basis for calculation of the amount of remuneration for inpatient services.

Outpatient Operation catalog

outpatient outpatient OP catalog 2016

With the Health Structural Law, hospitals were opened for outpatient surgery, with the aim of avoiding unnecessary full-hospital treatment, ensuring economic and patient care, and improving the cooperation between established contract doctors and hospitals.
Outpatient surgeries are usually carried out by a resident contractor.

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