39. Amendment of the agreement on forms for statutory health care

Article 1

Changes to the form agreement (Annex 2 BMV-Ä)

1. Numbers 2.60.1 to 2.60.3 are deleted.

2. Numbers 2.60, 2.61, 2.61. 1, 2.61.2, and 2.61.3 are changed as follows:

"2.60 unoccupied 1

2.61 Part A: Advice on medical rehabilitation / examination of the responsible rehabilitation provider

Part B to D: Ordinance on medical rehabilitation (as of 4.2016)

2.61.1 On part A of model 61, contract similar Doctors arrange for additional advice on medical rehabilitation from the health insurance company (or let the health insurance company identify the responsible rehabilitation provider if this cannot be conclusively assessed by the contract doctor). In this case only part A has to be filled out and sent to the health insurance company. The health insurance company informs the contract doctor about the responsible rehabilitation provider.

2.61.2 Sample 61 (Part A) a: Copy for the contract doctor

Sample 61 (Part A) b: Copy to remain with the health insurance company

The complete copy set is first sent by the contract doctor to the health insurance fund, which then sends the original back to the contract doctor .

2.61.3 The prescription of medical rehabilitation at the expense of the statutory health insurance is to be made on the attached sample 61 (parts B to D). “

3. The numbers 2.61.4 and 2.61.5 are inserted as follows:

"2.61.4 Sample 61 (Parts B to D) : Copy to remain with the health insurance company Sample 61 (parts B to D) b: Copy to remain with the contracted doctor

2.61.5 Sample 61 consists of four two-part sets of forms with adhesive headers carbonless paper . For the surface printing on the samples 61Aa, 61Ba, 61Ca and 61Da, yellow should be used. The patterns 61Ab, 61Bb, 61Cb and 61Db do not receive colored surface print. No. 1.1.5 applies accordingly. The form is in A4 format. “

Article 2

Changes to the explanations of the form

1. The form explanations for sample 60 are deleted. 2

2.

Article 1

Changes to the form agreement (Annex 2 BMV-Ä)

1. Numbers 2.60.1 to 2.60.3 are deleted.

2. Numbers 2.60, 2.61, 2.61. 1, 2.61.2, and 2.61.3 are changed as follows:

"2.60 unoccupied 1

2.61 Part A: Advice on medical rehabilitation / examination of the responsible rehabilitation provider

Part B to D: Ordinance on medical rehabilitation (as of 4.2016)

2.61.1 On part A of model 61, contract similar Doctors arrange for additional advice on medical rehabilitation from the health insurance company (or let the health insurance company identify the responsible rehabilitation provider if this cannot be conclusively assessed by the contract doctor). In this case only part A has to be filled out and sent to the health insurance company. The health insurance company informs the contract doctor about the responsible rehabilitation provider.

2.61.2 Sample 61 (Part A) a: Copy for the contract doctor

Sample 61 (Part A) b: Copy to remain with the health insurance company

The complete copy set is first sent by the contract doctor to the health insurance fund, which then sends the original back to the contract doctor .

2.61.3 The prescription of medical rehabilitation at the expense of the statutory health insurance is to be made on the attached sample 61 (parts B to D). “

3. The numbers 2.61.4 and 2.61.5 are inserted as follows:

"2.61.4 Sample 61 (Parts B to D) : Copy to remain with the health insurance company Sample 61 (parts B to D) b: Copy to remain with the contracted doctor

2.61.5 Sample 61 consists of four two-part sets of forms with adhesive headers carbonless paper . For the surface printing on the samples 61Aa, 61Ba, 61Ca and 61Da, yellow should be used. The patterns 61Ab, 61Bb, 61Cb and 61Db do not receive colored surface print. No. 1.1.5 applies accordingly. The form is in A4 format. “

Article 2

Changes to the explanations of the form

1. The form explanations for sample 60 are deleted. 2

2. The form explanations for sample 61 change as follows:

"Sample 61 Part A: Advice on medical rehabilitation / examination of the responsible rehabilitation provider

Under Part A of Model 61, contract doctors can arrange for additional advice from the health insurance company (e.g. if there is equal responsibility for child rehabilitation services or oncological rehabilitation for old-age pensioners or relatives of insured persons or pensioners) or by the responsible rehabilitation agency Have the health insurance company determined if this cannot be conclusively assessed by the contract doctor (e.g. with regard to the statutory requirements of the pension insurance). In this case only part A has to be filled out and sent to the health insurance company. The health insurance company informs the contract doctor about the responsible rehabilitation provider. If the health insurance company is responsible, the contract doctors are asked to also fill in part B-D of model 61 and send it to the health insurance company. In order to make it easier for the prescribing contract physicians to delimit the responsible rehabilitation provider, corresponding criteria are listed in Part A of the template. If there is clarity about the responsibility of the health insurance company, you can dispense with filling out Part A and fill out Part B-D and send it to the health insurance company.

The form is divided into three sections. Please note the following when filling out the fields:

I . Diagnoses justifying rehabilitation and other diagnoses

1
In this section, the diagnoses justifying the performance, but also other diagnoses relevant to the rehabilitation process must be given. The diagnoses are to be coded according to ICD-10-GM. They can also be given as free text; this is necessary in cases in which the diagnosis cannot be adequately mapped using the ICD-10-GM encryption.
2
If necessary and if it does not result from the ICD-10-GM, the side location must be specified (R = right, L = left, B = both sides).
3
If known, (possible) causes can be assigned to the individual diagnoses (e.g. accident at work, occupational disease, consequences of damage caused by the action of third parties, e.g. consequences of accidents, etc.). These only need to be stated if one of the causes listed there applies. The form contains corresponding selection under I.

II. The form explanations for sample 61 change as follows:

"Sample 61 Part A: Advice on medical rehabilitation / examination of the responsible rehabilitation provider

Under Part A of Model 61, contract doctors can arrange for additional advice from the health insurance company (e.g. if there is equal responsibility for child rehabilitation services or oncological rehabilitation for old-age pensioners or relatives of insured persons or pensioners) or by the responsible rehabilitation agency Have the health insurance company determined if this cannot be conclusively assessed by the contract doctor (e.g. with regard to the statutory requirements of the pension insurance). In this case only part A has to be filled out and sent to the health insurance company. The health insurance company informs the contract doctor about the responsible rehabilitation provider. If the health insurance company is responsible, the contract doctors are asked to also fill in part B-D of model 61 and send it to the health insurance company. In order to make it easier for the prescribing contract physicians to delimit the responsible rehabilitation provider, corresponding criteria are listed in Part A of the template. If there is clarity about the responsibility of the health insurance company, you can dispense with filling out Part A and fill out Part B-D and send it to the health insurance company.

The form is divided into three sections. Please note the following when filling out the fields:

I . Diagnoses justifying rehabilitation and other diagnoses

1
In this section, the diagnoses justifying the performance, but also other diagnoses relevant to the rehabilitation process must be given. The diagnoses are to be coded according to ICD-10-GM. They can also be given as free text; this is necessary in cases in which the diagnosis cannot be adequately mapped using the ICD-10-GM encryption.
2
If necessary and if it does not result from the ICD-10-GM, the side location must be specified (R = right, L = left, B = both sides).
3
If known, (possible) causes can be assigned to the individual diagnoses (e.g. accident at work, occupational disease, consequences of damage caused by the action of third parties, e.g. consequences of accidents, etc.). These only need to be stated if one of the causes listed there applies. The form contains corresponding selection under I.

II.Note / request to the health insurance company

Advice to the insured person

4
The box can be checked if advice to the insured person about medical rehabilitation services from the health insurance company or another rehabilitation provider is indicated. This can e.g. be the case if there is equal responsibility for child rehabilitation services or for oncological rehabilitation for retirees or relatives of insured persons or pensioners. In addition, the box can be filled in if advice on other health insurance benefits (e.g. medical care in recognized health resorts) is indicated. If this is the case, only part A of the form needs to be sent to the health insurance company. Part BD of the form then does not have to be filled out.

Examination of the responsible rehabilitation provider

5
If reduction in the Ability to work exists or threatens and eg If the statutory requirements of the pension insurance cannot be clearly assessed, the competent rehabilitation institution can be asked to examine. If this is the case, only part A of the form needs to be sent to the health insurance company. Part B-D of the form does not then have to be filled out.

If applicable Further comments from the contract doctor

6
Here you can add further information from the contract doctor, e.g. the request for callback can be made by the health insurance company.

III. Return the original to the contract doctor

7
If the contract doctor has asked the responsible rehabilitation provider to be checked, the health insurance company will notify the contract doctor whether the health insurance class is responsible (the contract doctor then has to fill out part BD of the form), the pension insurance is responsible (the health insurance company then sends the pension insurance form to the contract doctor) or another cost carrier is responsible .

Sample 61 Parts B to D: Ordinance on Medical Rehabilitation

Under Part BD, contract doctors can provide medical rehabilitation and medical rehabilitation services for mothers and fathers. The sample is kept in the contract doctor's practice.Note / request to the health insurance company

Advice to the insured person

4
The box can be checked if advice to the insured person about medical rehabilitation services from the health insurance company or another rehabilitation provider is indicated. This can e.g. be the case if there is equal responsibility for child rehabilitation services or for oncological rehabilitation for retirees or relatives of insured persons or pensioners. In addition, the box can be filled in if advice on other health insurance benefits (e.g. medical care in recognized health resorts) is indicated. If this is the case, only part A of the form needs to be sent to the health insurance company. Part BD of the form then does not have to be filled out.

Examination of the responsible rehabilitation provider

5
If reduction in the Ability to work exists or threatens and eg If the statutory requirements of the pension insurance cannot be clearly assessed, the competent rehabilitation institution can be asked to examine. If this is the case, only part A of the form needs to be sent to the health insurance company. Part B-D of the form does not then have to be filled out. Further comments from the contract doctor

6
Here you can add further information from the contract doctor, e.g. the request for callback can be made by the health insurance company.

III. Return the original to the contract doctor

7
If the contract doctor has asked the responsible rehabilitation provider to be checked, the health insurance company will notify the contract doctor whether the health insurance class is responsible (the contract doctor then has to fill out part BD of the form), the pension insurance is responsible (the health insurance company then sends the pension insurance form to the contract doctor) or another cost carrier is responsible .

Sample 61 Parts B to D: Ordinance on Medical Rehabilitation

Under Part BD, contract doctors can provide medical rehabilitation and medical rehabilitation services for mothers and fathers. The sample is kept in the contract doctor's practice.

When using sample 61 part BD, it should be noted that the health insurance company will only provide medical rehabilitation benefits if

  • curative individual services of outpatient treatment are not sufficient and
  • complex service for medical rehabilitation is medically indicated and no other rehabilitation provider is responsible.

The form is divided into seven sections. Please note the following when filling out the fields:

of medical rehabilitation

1
The box must be ticked if
  • is not reduction / significant risk the ability to work and
  • also does not concern the consequences of an accident at work / an occupational disease,

da in In these cases, other rehabilitation providers (statutory pension or accident insurance) are generally responsible.

2
Child rehabilitation or oncological rehabilitation benefits for retirees or relatives of the insured or pensioners are both at the expense of Re nten insurance and health insurance (equal responsibility). If the insured person wishes to be provided by the pension insurance, the health insurance company is not responsible and the pension insurance form must be filled out.

The box only needs to be ticked if the insured person after prior consultation (see sample 61, part A) wishes the performance of the service in the responsibility of the health insurance company. Diagnoses justifying rehabilitation and other diagnoses

3
In this section, the diagnoses justifying the performance, but also other diagnoses relevant to the rehabilitation process are to be given. The diagnoses are to be encoded in accordance with the ICD-10-GM. They can also be given as free text; this is necessary in cases in which the diagnosis cannot be adequately mapped using the ICD-10-GM encryption.
4
If necessary and if it does not result from the ICD-10-GM, the side location must be specified (R = right, L = left, B = both sides).

When using sample 61 part BD, it should be noted that the health insurance company will only provide medical rehabilitation benefits if

  • curative individual services of outpatient treatment are not sufficient and
  • complex service for medical rehabilitation is medically indicated and no other rehabilitation provider is responsible.

The form is divided into seven sections. Please note the following when filling out the fields:

of medical rehabilitation

1
The box must be ticked if
  • is not reduction / significant risk the ability to work and
  • also does not concern the consequences of an accident at work / an occupational disease,

da in In these cases, other rehabilitation providers (statutory pension or accident insurance) are generally responsible.

2
Child rehabilitation or oncological rehabilitation benefits for retirees or relatives of the insured or pensioners are both at the expense of Re nten insurance and health insurance (equal responsibility). If the insured person wishes to be provided by the pension insurance, the health insurance company is not responsible and the pension insurance form must be filled out.

The box only needs to be ticked if the insured person after prior consultation (see sample 61, part A) wishes the performance of the service in the responsibility of the health insurance company. Diagnoses justifying rehabilitation and other diagnoses

3
In this section, the diagnoses justifying the performance, but also other diagnoses relevant to the rehabilitation process are to be given. The diagnoses are to be encoded in accordance with the ICD-10-GM. They can also be given as free text; this is necessary in cases in which the diagnosis cannot be adequately mapped using the ICD-10-GM encryption.
4
If necessary and if it does not result from the ICD-10-GM, the side location must be specified (R = right, L = left, B = both sides).

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