Service catalog

	Financial flows in the Austrian healthcare system
	(Fin) Ministry of Finance distributes the budget for the Ministry of Health ; ; * flows directly to KV carriers; ; ** flows via pharmacy to health insurance providers; ; (←) partly direct reimbursement or exemption for mandatory verse. ; Reds: Government Sector, ; Yellows: Private Sector; Diagram according to Ziniel (2005)

The BMASGK 2020 service catalog (or earlier: Catalog of individual medical services , also: MEL catalog ) from the Austrian LKF system is the funding- relevant documentation basis for the majority of Austrian hospitals with regard to operations and medical services.

Basics

The service catalog was introduced in 1997 and has since been maintained annually by the respective federal ministry responsible for health.

2,020 individual medical services (MEL) are listed in 26 chapters (as of 2019), 160 of which are currently not financially relevant services such as residual classes from "other operations", physiotherapy or services covered by the health insurance companies.

The service catalog is a mixture of organ and procedure- related classification and a billing catalog. The parameters for documentation for patients in intensive care units such as the SAPS 3 or TISS -A are described separately in the LKF system.

The services are provided with five-digit alphanumeric codes, currently between AA010 and ZZ040. For the correct application of the service catalog, coding explanations are given in a manual Medical Documentation .

Concept of operation

An operation is basically any procedure that

a cut and a seam ,
a cut without a suture if the suture is not indicated for medical reasons, or
requires a suture without a cut due to a traumatic cause.

All services of the non-operative part of the service catalog do not represent an operation. H. med. Services that are not under. .9 or the catalog of services are to be encoded, represent the following services, even if they are performed under regional or general anesthesia and regardless of where they are performed (operating theater, surgery room, etc.):

Diagnostic and therapeutic endoscopies through preformed body openings, also when performing biopsies
Diagnostic or therapeutic insertion of catheters or probes through preformed or pathologically created body openings
Percutaneous harvesting of tissues, body fluids and air for diagnostic and therapeutic purposes without skin incision
Percutaneous insertion of catheters and probes for diagnostic and therapeutic purposes, also with sutures
Treatment of wounds, incisions or defects without sutures
Removal of superficial skin or mucous membrane changes without sutures
Treatment of fractures and dislocations with / without plaster casts and / or extensions
Closed joint mobilizations
Closed corrections and repositions of congenital or acquired misalignments of organs and body parts
Closed removal of foreign objects
Opening and draining abscesses without incision

Day clinical services

In day-care services, these are to certain operating results and selected non-surgical inpatient medical individual services that can be rendered within twelve hours if:

basically the patients have been clarified in advance and have been admitted to the hospital as planned (no emergencies),
a systemized bed is used for the patient, beds in the day clinic being systemized beds,
the service to be provided comes from the valid daily clinical service catalog and
Nursing and outpatient or inpatient medical follow-up is guaranteed.

The prerequisites for billing day clinical services are:

The billing of day-clinic services must correspond to the supply order of the hospital.
The operative and non-operative service items from the valid daily clinical service catalog can be billed.
Admission to the day clinic can only take place in the case of institutional need and should be documented with the admission type "K" in the diagnosis and performance report.
Day clinic beds are systemized beds. It is possible to run an interdisciplinary day clinic. In this case a separate cost center must be set up. When integrating the day clinic for each specialist department into the wards of this department, no separate cost center has to be set up.
More than one patient per day can be treated and billed on a day hospital bed.

Day clinical cases with discharge and subsequent resumption on the same day can only be billed in individual cases if there is an appropriate justification.

Examples of achievements

MEL BF020: extracapsular cataract surgery with lens implantation
MEL HH040: Appendectomy - open
MEL NF020: arthroscopic surgery of the knee joint
MEL ZA010: Computed Tomography - Head and Neck
MEL AM010: Psychotherapy as part of an inpatient stay
MEL XC990: continuation of chemotherapy

Service catalog in Germany

Name for all services of the statutory health insurance to which the insured are entitled from the health insurance companies. The service catalog is continuously checked by the Federal Joint Committee for the diagnostic and therapeutic benefits of the individual services.

Web links

Performance- oriented hospital financing (LKF) - Current information on service catalogs (download, etc.) and performance-oriented hospital financing

Catalogs - Archived page (on web.archive.org) on the former website of the BMG, on which the service catalog was available in various formats

Individual evidence

↑ Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.

[1] Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.

Financial flows in the Austrian healthcare system
		Bonuses						→	Private insurance					Special services

														Catalog services ( after DRG )

		Contributions						→	Health insurance ( compulsory insurance)

		Taxes						FA →

			→	BM (Fin)					countries				→	BGA

						Art. 15a BV-G					↓	budget				←
														Country Fund ( LGF)
										→			→
											↓
population					Deductibles				Fund KA				←

AN , AG				(←)				→					←		fee		←
									Private KA
					some deductibles *								←	PRIKRAF		←

														Expense coverage

or.				(←)				→	Outpatient clinic				←

					some deductibles *									Flat rate + individual services

				(←)				→	(practicing) doctor				←
														Exp. f. Drugs + of pharmacy services
					Prescription fee **

patient				(←)				→	pharmacy				←

	↑
							reimbursement
(Fin) Ministry of Finance distributes the budget for the Ministry of Health ; * flows directly to KV carriers; flows via pharmacy to health insurance providers; (←)** partly direct reimbursement or exemption for mandatory verse. Reds: Government Sector, Yellows: Private Sector Diagram according to Ziniel (2005)