Help for hospitals through COVID-19 Hospital Relief Act? Compensation payments to hospitals due to special burdens caused by COVID-19
Contrary to the DKG's demand, no monthly payments on account were granted, but the following basic regulations were made, none of which necessarily involve less bureaucracy:
1. compensation payments to hospitals due to special burdens caused by COVID-19
According to the COVID Act, hospitals receive compensation payments if they have had to postpone or suspend scheduled admissions, operations and procedures for the care of COVID patients.
The amount of the compensation payments is to be determined by deducting the number of inpatients treated on the respective day from the average number of patients treated as full or partial inpatients per day in 2019 for the first time since 16.03.2020.
If the result obtained is greater than zero, it is multiplied by the daily flat rate of EUR 560. It seems questionable that only one uniform flat rate was determined for each hospital in Germany. The differences in cost and revenue structure, in regional and specialist terms are thus leveled out. Whether this very rough standardization at the expense of greater individual fairness is justified, for example to achieve administrative simplification and thus acceleration, is at least questionable. Affected hospitals should keep a close eye on the effects based on their own specific structure. If this standard flat rate leads to excessive distortions, this legislative measure should be reviewed.
This calculated amount is to be reported to the authority responsible for hospital planning on a weekly basis, differentiated by calendar day.
The contracting parties pursuant to Section 17b (2) KHG are still to determine the details of the procedure for verifying the number of patients treated daily on a full and partial inpatient basis in comparison to the reference value for determining and reporting. It is therefore to be hoped that the bureaucratic effort in this regard will be kept to a minimum.
2. additional intensive care treatment capacities
Hospitals that create additional intensive care treatment capacities with mechanical ventilation options by setting up beds or by incorporating beds from other wards will receive a one-off amount of EUR 50,000 for each bed set up or maintained until September 30, 2020. It is to be hoped that high hurdles will not be placed on the definition and proof of this additional intensive care. The explanatory memorandum to the law already restricts this further, as it also requires extended monitoring in addition to ventilation, but this is not reflected in the wording. Hospitals that create additional places should therefore ensure that they document the presence of monitoring in accordance with the explanatory memorandum (ECG, SpO2, IBP, BGA) as a precautionary measure.
3. flat-rate compensation for price and volume increases for protective clothing etc.
Furthermore, hospitals may claim a flat-rate surcharge of EUR 50 for each patient admitted for full or partial inpatient treatment between April 1, 2020 and June 30, 2020 to compensate for price and volume increases due to the coronavirus.
4. test quota and penalties
The audit rate will be reduced from 12.5% to 5% for 2020. The surcharge of 10% of the difference will also no longer apply for 2020. Furthermore, the stricter regulation, which differentiates the percentage surcharge according to the proportion of unobjected invoices, will only come into force from 2021. Hospitals should therefore keep an eye on their audit quota on a daily basis and, if it has already been met, indicate this immediately in the event of new audits.
The submission of the certificate regarding compliance with the structural features will also be postponed by one year, so that invoicing is still possible without submitting this certificate until the end of 2021. If possible, however, the time should be used to prepare for the structural audits and applications.
5. shortened payment deadline
The services provided and invoiced by the hospitals by December 31, 2020 must be paid by the health insurance funds within 5 days of receipt of the invoice.
This depends on when the invoice is received, so hospitals are advised to keep a close eye on the payment deadline in order to be able to charge interest on arrears to the health insurance funds afterwards.
There are increasing reports that, since the MDK Reform Act prohibits offsetting, individual health insurance funds have begun to reject invoices with certain OPS as standard. It is doubtful whether such a procedure corresponds to the intention of the legislator. After all, the rejection of an invoice within the 5-day period also requires a plausibility check by a clerk. In addition, the check quota must continue to be observed and must not be circumvented in this way.
6. financing of care costs
The provisional care fee value will be increased to EUR 185 for the calculation of daily care fees from April 1, 2020. In the event of a shortfall in the hospital's nursing staff costs, a peak settlement will be made in which the nursing revenues generated with the provisional nursing fee value will be compared with the agreed actual nursing staff costs, while in the event of an over-recovery of nursing staff costs for 2020, there will be no compensation for the overpaid funds.
Accordingly, nursing staff costs that are not adequately financed with the provisional nursing fee value are to be fully compensated. This makes a differentiated, autonomous calculation of personnel costs all the more important, as experience has shown that this does not necessarily correspond to the accounting classification of cost items as material vs. personnel costs.
7. suspension of the regulation on lower limits for nursing staff
The criticism from hospital lawyers that the publication of the BMG's simple legal opinion in a letter from the Minister on March 4, 2020 did not provide hospitals with legal certainty has obviously borne fruit:
The Nursing Staff Lower Limits Ordinance was temporarily suspended with the first ordinance amending the Nursing Staff Lower Limits Ordinance with effect from March 01 up to and including December 31, 2020.
As a result, there is no longer a risk that the health insurance funds will deny the existence of an exception in accordance with Section 8 of the Nursing Staff Minimum Limits Ordinance in times after the crisis and that each hospital would have to prove this individually in each treatment case examined in this regard.