What does the MDK do??
Everyone has heard of the MDK at one time or another – whether it's because their grandparents have applied for a care degree or because a medical service was required for which it was not clear whether the health insurance would cover it. The assessment generally concerns the need for care, rehab applications, disputed decisions about medical care or clarification of incapacity for work. But these are not the only areas of work of the MDK.
Assessments for the health insurance funds
The MDK supports and advises the health insurance companies on medical and care ies to be assessed independently and neutrally. The doctors of the MDK are only subject to their medical conscience. May not intervene in treatment.
The appraisal can take place after file situation, or it can be necessary the investigation by the MDK. The patient is then invited to an MD consultation center near his or her home. Subsequently, an expert opinion is written, on the basis of which the health insurance company decides on the service to be provided. This can be in the following areas, for example:
– Approval of preventive and rehabilitation measures – Clarification of incapacity for work – Use of remedies and aids – Appropriateness of dental services – Evaluation of new or unconventional examination and treatment methods
Assessment for the nursing care insurance companies
For the nursing care insurance companies, the MDK assesses the need for nursing care of patients and determines which degree of nursing care exists. The assessment is carried out by specially trained nursing professionals at home or in the nursing home. About the result of the test. The MDK informs the respective care insurance company of the care degree.
Care quality audits
The MDK inspects the quality in outpatient services and nursing homes annually. Focus on the comprehensive, individual care situation of the person in need of care. It is about questions of mobility and self-sufficiency, about how the facility cares for and supports the residents in case of illness and necessary therapies, but also about how everyday life is organized and whether social contacts are promoted. The focus of the audits is on the MDK's expert nursing advice.
In Bremen, all facilities are inspected once a year. This is how deficiencies are detected. Countermeasures can be taken. The results of the tests are included in the vdek nursing guide. People in need of care and their relatives can obtain comprehensive information there about the quality, prices and services offered by care facilities.
If a treatment error is suspected, patients should first contact their health insurance company. There they get support, if it concerns claims for damages. For this purpose, the health insurance company can commission the MDK to conduct an assessment. The aim is to clarify whether the treatment was in accordance with accepted medical standards, or whether there was a treatment error. The expert opinion is free of charge for insured persons and can be used in court or against the practitioner's liability insurance. In 2019, the medical services of the health insurance (MDK) have nationwide 14.553 specialist's opinion on suspected treatment errors. In every fourth case an error was confirmed.
Examination of hospital bills
The health insurance companies are legally obligated to have conspicuous invoices of the hospitals checked by the medical services. Checking whether the medical facts and the billing coding are correct. Was the inpatient treatment necessary? Were the treatment procedures presented correctly. Were they billed correctly? As a result of the audits, no hospital can gain an advantage through increased billing. Ensuring that the insured's money is used wisely.
Individual health services are referred to as IGeL services. They are medical services that are not covered by statutory health insurance because their benefits are too small or cannot be scientifically proven. Many medical practices offer these services to their patients for private payment. The Medical Service of the National Association of Health Insurance Funds (MDS) regularly publishes and updates the IGeL Monitor.