Announcements
The Federal Association
, Kdö.R., Berlin - on the one hand - and the GKV-Spitzenverband (Central Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:51. Change to the agreement on forms for statutory health care from April 1, 1995 (Annex 2 BMV-Ä)
Article 1
Changes to the form agreement
1. Number 2.6 changes as follows:
" Sample 6: Transfer slip (as of: 10.2019) “
2. Number 2.10 changes as follows:
“ Sample 10: Transfer slip for laboratory tests as an order service (as of 10.2019) "
3. Number 2.10A changes as follows:
" Sample 10A: Request form for laboratory tests for laboratory communities (as of 10.2019) "
4. Number 2.29 changes as follows:
" 2.29 to 2.35 unoccupied “1
5. The numbers 2.30, 2.30.1 and 2.30.2 are deleted.1
6. The entry for numbers 2.31 to 2.35 is deleted. 1
Article 2
Changes to the form explanations
1. The form explanation for sample 5 changes under No. 6 as follows:
"6. The sex of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card. “
2. The form explanation for sample 6 changes as follows:
" Sample 6: Transfer slip
The transfer slip is used to transfer the necessary diagnostic or therapeutic services to another contract doctor, an institution approved in accordance with Section 311, Paragraph 2, Clauses 1 and 2 SGB V, medical care center, an authorized doctor or an authorized, medically managed institution. A referral slip is also to be used if the contract doctor has an outpatient operation in the hospital, an outpatient treatment in the hospital according to § 116b SGB V (in the version valid until December 31, 2011) or an assignment to outpatient specialist care according to § 116b SGB V causes. Medical services provided as part of the breast cancer early detection program through mammography screening do not require referral. Announcements The Federal Association
51. Change to the agreement on forms for statutory health care from April 1, 1995 (Annex 2 BMV-Ä)
Article 1
Changes to the form agreement
1. Number 2.6 changes as follows:
" Sample 6: Transfer slip (as of: 10.2019) “
2. Number 2.10 changes as follows:
“ Sample 10: Transfer slip for laboratory tests as an order service (as of 10.2019) "
3. Number 2.10A changes as follows:
" Sample 10A: Request form for laboratory tests for laboratory communities (as of 10.2019) "
4. Number 2.29 changes as follows:
" 2.29 to 2.35 unoccupied “1
5. The numbers 2.30, 2.30.1 and 2.30.2 are deleted.1
6. The entry for numbers 2.31 to 2.35 is deleted. 1
Article 2
Changes to the form explanations
1. The form explanation for sample 5 changes under No. 6 as follows:
"6. The sex of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card. “
2. The form explanation for sample 6 changes as follows:
" Sample 6: Transfer slip
The transfer slip is used to transfer the necessary diagnostic or therapeutic services to another contract doctor, an institution approved in accordance with Section 311, Paragraph 2, Clauses 1 and 2 SGB V, medical care center, an authorized doctor or an authorized, medically managed institution. A referral slip is also to be used if the contract doctor has an outpatient operation in the hospital, an outpatient treatment in the hospital according to § 116b SGB V (in the version valid until December 31, 2011) or an assignment to outpatient specialist care according to § 116b SGB V causes. Medical services provided as part of the breast cancer early detection program through mammography screening do not require referral.
A referral slip may only be issued if the referring contract doctor has been presented with valid electronic health card or proof of entitlement in accordance with Section 19 (2) BMV-Ä in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.
The doctor who acts on the referral is generally bound by the referral slip issued. In his statement, he indicates that the treatment was based on referral.
The health insurance companies inform their insured that the doctor who is referred to the referral also has the electronic health card, the transfer slip must also be presented.
The following information must be observed:
The referring contract doctor must indicate whether the referral is for curative care, for prevention, for the consultation of doctor in the case of attending medical treatment or as an assignment for treatment in accordance with Section 116b SGB V.
In outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is already provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in position 30 in the status field of the personal data field.
The quarter in which the referral was issued must be entered in the relevant field in the form "QJJ".
If the doctor acting on the referral begins his treatment The transfer slip issued can only be used in the following quarter, provided that the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of entitlement to claim.
Does the treatment of the doctor who acted on the referral extend to? If more than one quarter, the transfer slip can be used across quarters. It is not necessary to re-issue transfer slip.
A referral slip may only be issued if the referring contract doctor has been presented with valid electronic health card or proof of entitlement in accordance with Section 19 (2) BMV-Ä in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.
The doctor who acts on the referral is generally bound by the referral slip issued. In his statement, he indicates that the treatment was based on referral.
The health insurance companies inform their insured that the doctor who is referred to the referral also has the electronic health card, the transfer slip must also be presented.
The following information must be observed:
The referring contract doctor must indicate whether the referral is for curative care, for prevention, for the consultation of doctor in the case of attending medical treatment or as an assignment for treatment in accordance with Section 116b SGB V.
In outpatient specialist medical care (ASV), there is no referral requirement between the members of the core team. The specialists to be consulted provide their services as ASV entitled persons according to the respective scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is already provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in position 30 in the status field of the personal data field.
The quarter in which the referral was issued must be entered in the relevant field in the form "QJJ".
If the doctor acting on the referral begins his treatment The transfer slip issued can only be used in the following quarter, provided that the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of entitlement to claim.
Does the treatment of the doctor who acted on the referral extend to? If more than one quarter, the transfer slip can be used across quarters. It is not necessary to re-issue transfer slip.
The doctor who acts on referral is informed by ticking the accident field that the treatment is due to or becomes necessary as result of an accident. With the transfer of this information to the billing, the health insurance companies receive information on health damage caused by third parties and can, if necessary, assert corresponding claims for damages in order to relieve the financial burden on the statutory health care provider The doctor only becomes aware during his treatment that the treatment was necessary due to or as consequence of an accident, he documents this accordingly in his invoice. The same applies to an accident that only occurred while he was being treated.
Pattern 6 should not be used for accidents at work, occupational diseases and accidents at school. The treatment must be settled with the responsible accident insurance institution. For this purpose, the "medical accident report" (Form F 1050) according to the contract between doctors and accident insurance providers must be used. School accidents also include accidents of children in kindergartens and of students during their studies.
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card.
To ensure the free choice of doctor the referral should not be made out in the name of specific contract doctor, but in the area, sub-area or additional designation in whose area the examination or treatment is to be carried out. A transfer by name can be made to authorized doctors or authorized medically managed facilities to carry out certain examination or treatment methods.
It is to be checked whether the transfer is for the execution of Contract services, for consultation or for additional / further processing.
Execution of contract services
The transfer for the execution of contract services requires
1. the definition of the services according to type and scope (definition order) or
2.
The doctor who acts on referral is informed by ticking the accident field that the treatment is due to or becomes necessary as result of an accident. With the transfer of this information to the billing, the health insurance companies receive information on health damage caused by third parties and can, if necessary, assert corresponding claims for damages in order to relieve the financial burden on the statutory health care provider The doctor only becomes aware during his treatment that the treatment was necessary due to or as consequence of an accident, he documents this accordingly in his invoice. The same applies to an accident that only occurred while he was being treated.
Pattern 6 should not be used for accidents at work, occupational diseases and accidents at school. The treatment must be settled with the responsible accident insurance institution. For this purpose, the "medical accident report" (Form F 1050) according to the contract between doctors and accident insurance providers must be used. School accidents also include accidents of children in kindergartens and of students during their studies.
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card.
To ensure the free choice of doctor the referral should not be made out in the name of specific contract doctor, but in the area, sub-area or additional designation in whose area the examination or treatment is to be carried out. A transfer by name can be made to authorized doctors or authorized medically managed facilities to carry out certain examination or treatment methods.
It is to be checked whether the transfer is for the execution of Contract services, for consultation or for additional / further processing.
Execution of contract services
The transfer for the execution of contract services requires
1. the definition of the services according to type and scope (definition order) or
2.an indication of the indication with recommendation of the method (indication order).
The contract doctor placing the order is responsible for the necessity of placing the order. The cost-effectiveness of the execution of the order is to be guaranteed by the doctor carrying out the order.
The type and scope of the orders must be specifically determined (specification of the fee schedule item or the precise service description). The doctor executing the order may only provide the services specified under "Order". An extension of the order in terms of type or scope requires the consent of the contract doctor who placed the order.
The doctor performing an order service is entitled to parts of this order that he himself does not can be performed by another doctor as an order service (referral).
Consultant examination
With the referral for an independent examination diagnostic services are arranged, the type and scope of which the performing doctor decides. The reason for the investigation must be entered. The performing doctor is free to choose his diagnostic steps. These measures should be completed within reasonable period and the referring doctor should be informed of the result as soon as possible. Therapeutic measures are not billable.
If it is not possible to carry out an independent examination without using another doctor, the doctor who acts on referral can provide individual services as contract services from another doctor
Co-treatment / further treatment
The referral for co-treatment takes place for the area-related provision of accompanying or supplementary diagnostic or therapeutic measures, The contract doctor to whom the referral was made decides on the type and scope of this. In the case of referral for further treatment, the entire diagnostic and therapeutic work is transferred to the contracted doctor providing further treatment. The field "Co-treatment / further treatment" must also be ticked for transfers to carry out outpatient operations.
If so the referring contract doctor has certified an incapacity for work, he informs the doctor acting on the referral of the date of the expected end of the incapacity for work in the form "DDMMYY". This information is only required if the management of the treatment is to be passed on to the doctor providing further treatment.
For patients with limited entitlement to benefits in accordance with Section 16 Para.an indication of the indication with recommendation of the method (indication order).
The contract doctor placing the order is responsible for the necessity of placing the order. The cost-effectiveness of the execution of the order is to be guaranteed by the doctor carrying out the order.
The type and scope of the orders must be specifically determined (specification of the fee schedule item or the precise service description). The doctor executing the order may only provide the services specified under "Order". An extension of the order in terms of type or scope requires the consent of the contract doctor who placed the order.
The doctor performing an order service is entitled to parts of this order that he himself does not can be performed by another doctor as an order service (referral).
Consultant examination
With the referral for an independent examination diagnostic services are arranged, the type and scope of which the performing doctor decides. The reason for the investigation must be entered. The performing doctor is free to choose his diagnostic steps. These measures should be completed within reasonable period and the referring doctor should be informed of the result as soon as possible. Therapeutic measures are not billable.
If it is not possible to carry out an independent examination without using another doctor, the doctor who acts on referral can provide individual services as contract services from another doctor
Co-treatment / further treatment
The referral for co-treatment takes place for the area-related provision of accompanying or supplementary diagnostic or therapeutic measures, The contract doctor to whom the referral was made decides on the type and scope of this. In the case of referral for further treatment, the entire diagnostic and therapeutic work is transferred to the contracted doctor providing further treatment. The field "Co-treatment / further treatment" must also be ticked for transfers to carry out outpatient operations.
If so the referring contract doctor has certified an incapacity for work, he informs the doctor acting on the referral of the date of the expected end of the incapacity for work in the form "DDMMYY". This information is only required if the management of the treatment is to be passed on to the doctor providing further treatment.
For patients with limited entitlement to benefits in accordance with Section 16 Para.3a SGB V, the referring contract doctor has to tick the corresponding field in order to inform the doctor who acts on the referral about the limited entitlement to benefits.
Under "diagnosis / suspected diagnosis", "findings / medication" or "order" the referring contract doctor provides the relevant information, u m to give the doctor who acts on the referral information for his treatment and to avoid unnecessary costs through multiple examinations. The contract doctor who is also treating / continuing treatment should therefore also be informed about the findings and / or treatment measures that have been collected so far changes as follows:
"
"
4. The form explanation for sample 10 is changed in No. 6 as follows:
"
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card. “
5. The image file in the explanation of the form for sample 10A changes as follows:
„
<<
6. The form explanation for sample 10A changes in No. 4 as follows:
"
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card . "
7. The form explanation for sample 19 changes under No. 3 as follows:
" 3. The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The information is printed by reading the information from the electronic health card. "
8. In the explanation of the form, the entry" Sample 29: unoccupied “deleted.
9. The explanation of the form for sample 30 is deleted. 1
10. In the explanation of the form the entry for samples 31 to 35 changed as follows:
" samples 29 to 35: unoccupied " 1
Article 3
Entry into force
The deletion of sample 30 will take effect retrospectively as of April 1, 2019.
The changes to samples 5, 6, 10, 10A and 19 will take effect on October 1, 2019 Force. Old patterns have to be used up.3a SGB V, the referring contract doctor has to tick the corresponding field in order to inform the doctor who acts on the referral about the limited entitlement to benefits.
Under "diagnosis / suspected diagnosis", "findings / medication" or "order" the referring contract doctor provides the relevant information, u m to give the doctor who acts on the referral information for his treatment and to avoid unnecessary costs through multiple examinations. The contract doctor who is also treating / continuing treatment should therefore also be informed about the findings and / or treatment measures that have been collected so far changes as follows:
"
"
4. The form explanation for sample 10 is changed in No. 6 as follows:
"
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card. “
5. The image file in the explanation of the form for sample 10A changes as follows:
„
<<
6. The form explanation for sample 10A changes in No. 4 as follows:
"
The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The printing is done by reading the information from the electronic health card . "
7. The form explanation for sample 19 changes under No. 3 as follows:
" 3. The gender of the patient is indicated by letter (D = diverse, M = male, W = female, X = indefinite). The information is printed by reading the information from the electronic health card. "
8. In the explanation of the form, the entry" Sample 29: unoccupied “deleted.
9. The explanation of the form for sample 30 is deleted. 1
10. In the explanation of the form the entry for samples 31 to 35 changed as follows:
" samples 29 to 35: unoccupied " 1
Article 3
Entry into force
The deletion of sample 30 will take effect retrospectively as of April 1, 2019.
The changes to samples 5, 6, 10, 10A and 19 will take effect on October 1, 2019 Force. Old patterns have to be used up.
Berlin, May 13th, 2019
National Association of Statutory Health Insurance Physicians, Kdö.R., Berlin
GKV-Spitzenverband, Kdö.R., Berlin
1 The table of contents changes accordingly.
1 The table of contents changes accordingly.
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