Once more, the revision of the German DRG catalogue 2006 provides for more accurate reimbursement, particularly for specialised medical services. The newly established DRG I97Z (Rheumatologische Komplexbehandlung bei Krankheiten und Störungen an Muskel-Skelett-System und Bindegewebe) for the complex and multimodal treatment of rheumatic diseases allows an accurate picture of clinical practice in specialized rheumatologic departments and hospitals. Using this specific DRG-description, it will be possible to reduce the financial pressure which results from the redistribution of budgets in the second year of the period of convergence. A precondition for the affected hospitals is to deal with budget planning and calculation of G-DRGs without calculated cost weights for 2006. In addition, this article discusses the relevance of other modifications to the G-DRG system, additional payments, the conditions for payment, the coding standards, and the classification systems for diagnosis and procedures.
The following article presents the main general and specific changes in the G-DRG (German diagnosis-related groups) system in terms of the classification systems for diagnoses and procedures as well as the billing process for 2009. Of fundamental relevance is the national weighting of the G-DRG I97Z (complex rheumatologic treatment), which up to now had to be negotiated individually by each hospital. Emphasis is also put on case auditing by the health insurers. Being primarily a tool for redistribution of resources, every hospital has to analyze the economic effects of the 2009 G-DRG system by applying the G-DRG transition grouper to its own cases. Depending on their clinical focus rheumatological departments may experience positive or negative consequences from the development. The strain imposed on hospitals by inadequate refunding of rising costs has to be assessed separately from the effects of redistribution by the G-DRG system.
The following article presents the major general and specific changes in the G-DRG system, in the classification systems for diagnoses and procedures as well as for the billing process for 2010. Since the G-DRG system is primarily a tool for the redistribution of resources, every hospital needs to analyze the economic effects of the changes by applying the G-DRG transition-grouper to its own cases. Depending on their clinical focus, rheumatological departments may experience positive or negative consequences from the adjustments. In addition, relevant current case law is considered.
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