Association of Statutory Health Insurance Physicians in Bavaria
| Association of Statutory Health Insurance Physicians in Bavaria | |
|---|---|
|
|
| state |  Bavaria
|
| organization | Medical self-administration |
| legal form | Public corporation |
| Supervisory authority | Bavarian State Ministry for Health and Care |
| Headquarters | 80687 Munich , Elsenheimerstraße 39 |
| Board | Wolfgang Krombholz (chairman) Pedro Schmelz (1st vice chairman) Claudia Ritter-Rupp (2nd vice chairwoman) |
| Members | 25,750 doctors and psychotherapists |
| Fee turnover | 5.765 billion euros |
| Employee | 1,650 |
| Locations | * Munich
|
| Website | www.kvb.de |
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The Bavarian Association of Statutory Health Insurance Physicians (KVB) is the largest of the 17 associations of statutory health insurance physicians in Germany. As a corporation under public law , the KVB represents the interests of its members, the around 28,000 contract doctors and psychotherapists established in Bavaria , vis-à-vis politics, health insurance companies and the public. At the same time, as a de facto authority, it fulfills the tasks of security and warranty assigned to it by the legislature : The KVB ensures that general practitioners , specialists and psychotherapists are active throughout Bavaria who treat people with statutory health insurance on presentation of the electronic health card. And it ensures that the doctors and psychotherapists working in outpatient care are well trained, only use modern medical technology and use the financial resources of the statutory health insurance economically (economic efficiency requirement according to Section 12 SGB V). In addition, the KVB organizes the medical on-call service as well as the ground-based emergency doctor service in Bavaria.
The KVB is subject to the legal supervision of the Bavarian State Ministry for Health and Care (StMGP), but decides on its own responsibility within the framework of the requirements of the Fifth Social Code (SGB V) on its matters. It also carries out sovereign tasks and carries an official seal . The administrative costs of the KVB are borne by the administrative cost allocation of its members.
tasks
Backup order
The legislature has entrusted the medical self-administration - i.e. the 17 Statutory Health Insurance Physicians' Associations (KVen) in the federal states as well as the National Association of Statutory Health Insurance Physicians - with the security of contract medical care (security order according to § 72 / § 75 SGB V). Since 1999, this has also included psychotherapeutic care in addition to outpatient general practitioners and specialists. The KVen, together with the health insurance companies, act as partners in the joint self-administration to ensure that all legal requirements of SGB V are correctly implemented.
Within the legal framework, KVs and health insurance companies in the individual countries have the option of structuring outpatient care according to regional needs. For this reason, among other things, the outpatient care landscape in a city state like Berlin , Hamburg or Bremen looks different than in Germany's largest state in terms of area, the Free State of Bavaria .
However, KVB and health insurance companies in Bavaria do not have a completely free hand: In addition to the statutory provisions, there are also a number of other regulations to be observed that are valid nationwide, such as the decisions of the Federal Joint Committee (G-BA) on requirements planning . This regulates, for example, the maximum number of doctors in which specialty may settle in certain regions. Requirements from the nationwide requirements planning guideline must be taken into account for the KVB.
The KVB organizes outpatient care for the more than ten million people with statutory health insurance in Bavaria during and outside of the usual consultation hours in accordance with the security order. The aim is to provide care close to home while at the same time using the financial resources of statutory health insurance responsibly, i.e. the membership fees of those with statutory health insurance.
In Section 72 of the Book V of the Social Code, it says: “Contract medical care is to be regulated in such a way that adequate, appropriate and economic care for the insured is guaranteed, taking into account the generally recognized state of medical knowledge, and that medical services are appropriately remunerated. "
The backup order is valid around the clock, also outside of the usual office hours. Therefore, the resident doctors provide medical on-call service in addition to their work in the practice.
In addition, the KVB ensures emergency medical care in the ground-based emergency rescue. The legal mandate for this comes from the Bavarian Rescue Service Act ( Art. 14 BayRDG ).
Representation of interests
The KVB represents the interests of its members, the 25,750 contract doctors and psychotherapists resident in the Free State, in the following matters, among others:
Fee negotiations with health insurance companies
The KVB negotiates with the health insurance companies in Bavaria - on the basis of the specifications from the negotiations between the National Association of Statutory Health Insurance Physicians and the National Association of Health Insurance Funds - the total fee for all outpatient medical and psychotherapeutic services and concludes fee contracts for the total remuneration to be paid for outpatient care . In Bavaria, this amounts to an annual financial volume of around 5.765 billion euros. The negotiated total remuneration is distributed according to the fee distribution scale established by the KVB (in coordination with the medical professional associations) .
The KVB is not involved in contracts for family doctor-centered care between health insurance companies and the Bavarian Association of General Practitioners .
Billing and payment of fees
The KVB settles the billing of the medical and psychotherapeutic services provided by the health insurance companies on presentation of the electronic health card for its members and pays the fees to the contracted doctors and psychotherapists.
Advice for members and young medical professionals
The KVB advises its members on all areas of contract medical and psychotherapeutic activities. This concerns, among other things, questions of billing, regulation, profitability or practice management. In addition, the KVB supports doctors and psychotherapists who want to work in outpatient care - among other things with advice and financial support in accordance with the KVB's security guideline.
Professional and health policy commitment
The KVB advocates professional policy for its members: for the preservation of freelance work , freedom of establishment, the right of patients to choose a doctor freely and performance-based remuneration for medical and psychotherapeutic work.
Warranty order
The KVB is responsible for the quality and economic efficiency of outpatient medical and psychotherapeutic care in Bavaria.
The KVB guarantees to the health insurance companies that the outpatient services are properly provided by its members, the resident doctors and psychotherapists. The basis for this are laws, guidelines and contracts. The KVB's warranty mandate vis-à-vis the health insurance companies also includes checking the accounts of its members for plausibility and cost- effectiveness and monitoring the contractual medical obligations.
Thus, the KVB ensures that only those doctors and psychotherapists are active in contract medical care who
- are well educated and trained and thus act according to the generally recognized state of medical knowledge (§ 72 SGB V)
- use modern medical technology and tested devices
- Comply with hygiene regulations
- meet special requirements that are partially required for training, premises or equipment in the case of special medical or psychotherapeutic services
- Comply with documentation obligations
- Use statutory health insurance funds sparingly.
In addition, the KVB is responsible for checking the billing for plausibility : Using standardized procedures, it checks whether the type and amount of the services billed by doctors and psychotherapists are realistic.
In addition, the KVB has to pay attention to an economic regulation. This involves the prescription of medicines , medicinal - and aids . While there used to be more frequent recourse for doctors in the case of benchmark tests due to the high number of prescriptions (financial reimbursement by the health insurance companies against individual prescribing doctors), an active ingredient agreement now applies in Bavaria.
Individual evidence
- ↑ Federal Joint Committee: Requirements Planning Guideline. Retrieved January 17, 2017 .
- ↑ Statistics on insured persons, broken down by status, age, place of residence and type of health insurance company (reference date: July 1, 2016). Federal Ministry of Health, June 1, 2016, accessed on January 13, 2017 .
- ↑ KVB: KVB turnover statistics. (No longer available online.) Archived from the original on January 16, 2017 ; accessed on January 16, 2017 . Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ KVB: Security Policy of the KVB. Retrieved January 16, 2017 .
- ↑ KVB: KVB active substance agreement. Retrieved January 16, 2017 .
Coordinates: 48 ° 8 ′ 17.5 ″ N , 11 ° 31 ′ 19.5 ″ E