The German DRG system has achieved a complexity with the ongoing necessary adaptations due to new diagnostics and therapy methods, which can steadily increase the likelihood of coding errors and the ensuing follow-up costs due to tests and discussions with the MDK as well as the own administrative expenses.
In this context, new approaches to MDK management, which not only focus on the pure revenue and liquidity assurance of the hospital, but also use modern data-analytics methods to reveal systematic relationships in the causes of the loss areas and to consistently submit to quality assurance.
The MDK management supports the reduction of the MDK quota (number of test reports) and the resulting value of the litigation as well as a reduction of the MDK losses with the aim of a sustainable guarantee of the services rendered. In addition to looking back at the reasons and risk records for MDK cases, the MDK management provides an outlook on the future MDK risk of redemption and the target rates for the planning and the target agreement of the specialist departments. On the basis of the MDK reasons and the loss areas, measures are derived with regard to the documentation of main and secondary diagnoses, procedures and the length of stay for indications and DRGs together with the responsible chief doctors. On the basis of a detailed analysis, a cause check can be carried out on the level of the case and the necessary measures can be identified and, if necessary, transferred to other DRGs.
Whitepaper on MDK Management
MDK Management / Management of the Medical Service of Health Insurance Companies
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MDK Management / Management of the Medical Service of Health Insurance Companies: From primary revenue assurance to quality improvement through smart procedures and optimized reports for the right view of the core factors.
- Challenge and approach
- The most important value contributions of structured MDK management
- Multidimensional reporting
- MDK Risk and fields of action
- Measure Control
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