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Health insurance companies under pressure: KV RLP publishes the results of the recourse ranking!
Rhineland-Palatinate presents new data on audit applications from health insurance companies. KV RLP calls for reforms to relieve the burden on practices.
Health insurance companies under pressure: KV RLP publishes the results of the recourse ranking!
In Rhineland-Palatinate, the health insurance companies have sent numerous test applications to practices, which leads to considerable administrative effort. These applications often concern low recourse amounts with an amount in dispute of less than 300 euros. How ZWP Online reported, processing such cases often turns out to be unprofitable for both health insurance companies and practices. Health insurance companies are increasingly required to find a solution to this problem, as it affects both the efficiency of practices and the quality of patient care.
The Rhineland-Palatinate Association of Statutory Health Insurance Physicians (KV) has now published the top 10 health insurance companies that submit the most requests for testing. The KV RLP lists these funds on its website in order to create transparency and enable a discussion about the verification practice. What is particularly striking is that many of these audit applications contain errors in content that have no consequences for the health insurance companies, but are problematic for the practices because they have to prove that they billed or prescribed correctly. This can result in financial losses for the practices.
Claims on health insurance companies
In response to the high number of test applications, KV RLP has formulated four essential demands. These demands aim to reduce bureaucracy for practices and improve the quality of patient care:
- Einführung einer Bagatellgrenze für alle Prüfarten, um unwirtschaftliche Kleinstbeträge ohne große Sammelanträge auszuschließen.
- Umwandlung der Misstrauenskultur gegenüber Ärzten in eine Vertrauenskultur, unterstützt von Politik und Krankenkassen.
- Das Wirtschaftlichkeitsgebot soll auch für Krankenkassen gelten; falsch ausgestellte Prüfanträge müssen angemahnt werden.
- Wirtschaftlichkeitsprüfungen sollten nur bei begründetem Verdacht auf Unwirtschaftlichkeit durchgeführt werden, und nicht als Selbstzweck.
Background and further context
The recourse rankings are based on KV RLP data from billing and performance audits and represent an unadulterated view of the practice of health insurance companies. The order in which these health insurance companies are listed results from the sum of all audit applications, without taking the number of insured people into account. This highlights the challenges that practices face and the need for action at the policy level.
Essential additional information on the framework requirements for performance audits can be found in the document from the National Association of Statutory Health Insurance Physicians (KBV), which deals with the current requirements and procedures: KBV.