Preparation of medical reports

- in the field of inpatient hospital treatment;

- medical services in connection with outpatient and inpatient operations;

- in connection with medical services and in the case of non-medical practitioner services and medical treatment;

- in connection with medical services in the case of ophthalmological treatment;

- in connection with dental services of all main areas of activity;

- in the field of rehabilitation and follow-up treatment.

Preparation of medical reports in the field of inpatient hospital treatment for persons insured with the Postbeamtenkrankenkasse (PBeaKK) or persons for whom the PBeaKK provides aid benefits (hereinafter referred to as only insured persons).

The subject of the assessment are completed and upcoming inpatient hospital stays of persons insured with the PBeaKK.

The subject of the review is in particular:

a) Checking the medical necessity of a treatment (form, method, duration, etc.)

b) Review of patient-related medical necessity in individual cases (form, method, duration, etc.)

c) Explain treatment alternatives on request in individual cases

d) Review of questions relating to fees (proper billing of treatment according to the flat-rate case catalogue as well as DRG/GOÄ determination for treatments in private and foreign clinics)

e) The time required for questions (usually by telephone) about an ongoing expert opinion order is part of the expert opinion order and cannot be calculated separately.

Forms / subject of the review:

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment (individual cases):

A physical assessment must be carried out,

- if the PBeaKK commissions the physical assessment; this is usually the case in the case of appeals against decisions of the PBeaKK, or

- if, during the assessment on the basis of the file, the experts determine that a physical assessment is indispensable, in this case, the contractor obtains a permit from the PBeaKK and then schedules the assessment with the insured person of the PBeaKK.

Preparation of medical reports for medical services in connection with outpatient and inpatient operations for persons insured with the Postbeamtenkrankenkasse (PBeaKK) or for persons for whom the PBeaKK provides aid benefits (hereinafter referred to as insured persons).

The subject of the assessment is the medical services provided on the days of surgery.

Form of review:

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment: In certain cases, the assessment may exceptionally be carried out as a physical assessment. Such a case exists in particular:

- when the PBeaKK commissions the physical assessment (usually in the event of appeals against decisions of the PBeaKK).

- If the medical expert determines during the assessment on the basis of the file that a physical assessment is indispensable. In this case, the contractor obtains a permit from the PBeaKK and then schedules this with the insured person of the PBeaKK.

Preparation of medical reports in connection with medical services as well as in the case of non-medical practitioner services and medical treatments. Assessments in connection with ophthalmological treatment (Lot 4) or operations (Lot 2) are not covered.

The subject of the assessment is the medical necessity of medical services, non-medical practitioner services and medical treatments. In the case of medical bills, the appropriate fee according to the GOÄ is also the subject of the assessment.

Form of review:

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment (individual cases): In certain cases, the assessment may exceptionally also be carried out as a physical assessment. Such a case exists in particular:

- when the PBeaKK commissions the physical assessment (usually in the event of appeals against decisions of the PBeaKK).

- If the medical expert determines during the assessment on the basis of the file that a physical assessment is indispensable. In this case, the contractor obtains a permit from the PBeaKK and then schedules this with the insured person of the PBeaKK.

Preparation of medical reports in connection with medical services in the case of ophthalmological treatment for persons insured with the Postbeamtenkrankenkasse (PBeaKK) or for persons for whom the PBeaKK provides assistance (hereinafter referred to as insured persons).

The subject of the ophthalmological assessment is in particular:

(a) reviewing the medical necessity of a form of treatment/method and assessing its fee assessment;

b) Review of patient-related medical necessity on a case-by-case basis

(c) presentation of treatment alternatives;

d) Review of the question of fees (proper billing of medical treatments according to GOÄ),

e) check whether the correct approach of analogue billing exists,

f) Determination of whether medically necessary treatment exists and, if necessary, the determination of an alternative treatment.

Forms of assessment:

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment (individual cases): In certain cases, the assessment may exceptionally also be carried out as a physical assessment. Such a case exists in particular:

- when the PBeaKK commissions the physical assessment (usually in the event of appeals against decisions of the PBeaKK).

- If the medical expert determines during the assessment on the basis of the file that a physical assessment is indispensable. In this case, the contractor obtains a permit from the PBeaKK and then schedules this with the insured person of the PBeaKK.

Preparation of medical reports in connection with dental services of all main areas of activity for persons insured with the Postbeamtenkrankenkasse (PBeaKK) or for persons for whom the PBeaKK provides aid benefits (hereinafter referred to as insured persons).

In particular, the following aspects must be taken into account during the dental assessment:

a) checking the medical necessity of a treatment (form, method, etc.) and its assessment under the law on fees,

b) review of patient-related medical necessity on a case-by-case basis,

(c) present treatment alternatives, if applicable, and

d) Review of the question of fee law (proper billing of the treatment according to GOZ, GOÄ and approach of analogue billing).

Form of review:

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment: In individual cases, i.e. in the event of objections to our decisions, a physical assessment in examination rooms close to home (one-way distance up to 50 km distance) may be necessary.

In addition, a physical assessment is also carried out in other cases,

- if the PBeaKK commissions the physical assessment; this is usually the case in the case of appeals against decisions of the PBeaKK, or

- if, during the assessment on the basis of the file, the experts determine that a physical assessment is indispensable, in this case, the contractor obtains approval from PBeaKK and then schedules the assessment with the insured.

The service owed by the contractor is the preparation of medical reports in the field of rehabilitation and follow-up treatment for persons insured with the Postbeamtenkrankenkasse (PBeaKK) or persons for whom PBeaKK provides aid benefits (hereinafter referred to as "insured").

The subject of the assessment are upcoming or already started outpatient and inpatient rehabilitation measures / follow-up treatment.

The subject of the review is in particular:

a) Review of patient-related medical necessity

b) Checking the medical necessity of treatment (form, method, duration)

c) Presentation of treatment alternatives (identification of type, content and duration of the alternative)

d) The time required for questions (usually by telephone) about an ongoing expert opinion order is part of the expert opinion order and cannot be calculated separately.

a) According to the file situation: The assessment is generally carried out according to the file situation.

b) Physical assessment (individual cases): A physical assessment must be carried out,

- if the PBeaKK commissions the physical assessment; this is usually the case in the case of appeals against decisions of the PBeaKK, or

- if, during the assessment on the basis of the file, the experts determine that a physical assessment is indispensable, in this case, the contractor obtains a permit from the PBeaKK and then schedules the assessment with the insured person of the PBeaKK.