The dual financing of hospitals, with investment funding by the state and reimbursement for treatment by the health insurance companies, is unfortunately increasingly leading to hospitals not receiving all the funding to which they are entitled. For years, the federal states have not fulfilled their obligation to provide hospitals with full investment funding, and the health insurance funds also do not remunerate all the services provided by hospitals. For this reason, our advice in the area of hospital financing has been in increasing demand in recent years.
In this area, you as our client will benefit from our experience in connection with applications for all kinds of individual funding for investments by the state.
In addition, the area of remuneration for treamtents offered is becoming increasingly contentious between hospitals and health insurance companies. In order to avoid financial burdens for your hospital, we provide you with comprehensive support in connection with structural audits, in the future also by accompanying you in the application for the required approval. You can also rely on our expertise in disputes with the MD(K) regarding the fulfillment of the structural requirements of individual OPS codes. In advising you on the interpretation and application of the numerous GBA guidelines for the provision of treatments in hospitals, such as the minimum volume regulation or the specialised center regulation, we maintain an overview and develop legally secure strategies together with you.
If necessary, we also enforce the hospitals’ claims against the health insurance companies in court. At the same time, we defend hospitals against the health insurance companies’ claims for reimbursement for remuneration already payed. With our many years of experience, our excellent reputation and our specialized knowledge of health care law, we have been able to successfully handle numerous mass proceedings regarding the health insurance companies’ claims for repayment in recent years, either by winning a large number of cases or by concluding settlements in favour of our clients. If such a solution cannot be found and the legal and factual issues are of a fundamental nature, we also conduct proceedings for you before the social law and administrative law courts up to the Federal Social Law Court or the Federal Administrative Law Court.
Finally, we advise on the still relevant topic of billing for elective services and the personal provision of services within the scope of elective services. The high formal requirements of case law can quickly get out of sight in practice, so we keep an overview for you. Since we know how important it is to raise the awareness of physicians authorized to provide elective services, but also of patient admissions in this context, we offer your hospitals in-house training for your physicians authorized to provide elective services, in addition to consulting and, if necessary, revision or creation of new elective service agreements as well as individual agreements.