Implications for private health insurers
The new medical fee schedule fundamentally changes the billing logic and the underlying calculation principles. The previous principle of factor increases – for example with a 2.3 or 3.5-fold rate – will be replaced by a new system of hardship allowances. This has the following implications for product development: Plan lines that were previously based on fixed rates of increase have to be adjusted and the calculation models revised accordingly.
In addition, the new model necessitates simulating the effects of the new fee schedule on benefit expenditure and to adjust the benefit policy. Accompanying forecasts by the German Medical Association and the PKV-Verband suggest an increase in expenditure of 13.2 percent within the first three years.
But the implications for private health insurers go beyond that: the changes to medical invoicing also affect the requirements for document readout and automated claims processing. Input management and regulations must be adapted accordingly. The people responsible for processing are also facing radical changes – after decades of working with the same GOÄ structures, they have to adjust their verification procedures as well as other processes and take part in trainings to familiarize themselves with the new rules.