Decree of the Ministry of Health No. 134 / 1998 Coll.
Decree of the Ministry of Health issuing a list of health performance with points
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Effective from 01.07.1998
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134
DECLARATION
Ministry of Health
of 2 June 1998
issuing a list of health performance with point values
According to § 17 (4) of Act No. 48 / 1997 Coll., on Public Health Insurance and on the amendment and addition of certain related laws, the Ministry of Health provides:
The list of health performance with points is set out in the Annex.
Decree No. 45 / 1997 Coll., which publishes a list of health performance with point values, is hereby repealed.
This Decree shall take effect on 1 July 1998.
Minister:
Dr. Roith, MBA v. r.
Annex to Decree No 134 / 1998 Coll.
1. TEXT PART
Chapter 1
Explanation of the basic terms used in the list of health performance with points
| 1. | seznam výkonů | seznam zdravotních výkonů s bodovými hodnotami |
| 2. | zdravotní výkon | základní jednotka seznamu, popisující ucelenou činnost při poskytování hrazených služeb (dále jen výkon) |
| 3. | kategorie výkonu | kategorie úhrady výkonu - řadí výkon mezi výkony plně hrazené a hrazené za určitých podmínek |
| 4. | autorská odbornost | odbornost, která navrhla a odborně garantuje výkon |
| 5. | číslo výkonu | pětimístné číslo jednoznačně identifikující výkon v rámci seznamu výkonů |
| 6. | název výkonu | stručný text vystihující jednoznačně podstatu výkonu |
| 7. | popis výkonu | text, rozvíjející název výkonu, popisující výkon a případně jeho provedení |
| 8. | OM omezení místem | omezení pro vykazování výkonu podle Kapitoly 2 bodu 4 |
| 9. | OF omezení frekvencí | omezení pro vykazování výkonu frekvencí jeho provedení vztaženou na jednoho pojištěnce a jedno nebo více časových období |
| 10. | čas výkonu | čas výkonu v minutách. Autorská odbornost výkonu je rozhodující pro přiřazení minutové režijní sazby. Celková hodnota minutové režie výkonu se vypočte jako součin času výkonu a minutové režijní sazby příslušné k výkonům dané autorské odbornosti (viz kapitola 7). Čas výkonu vyjadřuje dobu, po kterou je pracoviště prováděním výkonu plně vytíženo. |
| 11. | nositel nositel výkonu | zdravotnický pracovník, který se podílí na provedení výkonu. K výkonu jsou přiřazeny osobní náklady jednoho nositele výkonu, pouze výjimečně více nositelů (operační výkony a podobně). Je-li nositelem výkonu alespoň jeden lékař nebo jiný vysokoškolský pracovník, nejsou zásadně k výkonu přiřazeny osobní náklady nelékařských zdravotnických pracovníků (jsou obsaženy v úhradě nepřímých nákladů - režii). |
| 12. | čas čas nositele výkonu | čas, po který je daný zdravotnický pracovník zaměstnán prováděním právě tohoto jediného výkonu |
| 13. | INDX mzdový index nositele výkonu | index, který charakterizuje kvalifikaci nositele k provedení výkonu a obtížnost provedení výkonu |
| 14. | bodová hodnota výkonu | součet všech přímých nákladů na výkon, které zahrnují náklady na jednoúčelové přístroje a jejich specifickou údržbu, při provedení výkonu přímo spotřebovaný zdravotnický materiál a při provedení výkonu přímo spotřebované léčivé přípravky, osobních nákladů nositele výkonu a režijních nákladů vyjádřený v bodech |
| 15. | ZUM | zvlášť účtovaný zdravotnický materiál, který lze zvlášť účtovat k výkonu, pokud byl odůvodněně při výkonu spotřebován |
| 16. | ZULP | zvlášť účtovaný léčivý přípravek, který lze zvlášť účtovat k výkonu, pokud byl odůvodněně při výkonu spotřebován |
| 17. | OD | ošetřovací den |
| 18. | ZP | zdravotnické prostředky |
| 19. | centrum vysoce specializované péče | poskytovatel, který je podle zákona o zdravotních službách držitelem statutu centra vysoce specializované zdravotní péče nebo centra vysoce specializované zdravotní péče pro pacienty se vzácným onemocněním, nebo spolupracujícím poskytovatelem s takovým poskytovatelem pro účely udělení nebo získání tohoto statutu |
| 20. | BMI | Index tělesné hmotnosti (Body mass index) |
Chapter 2
General rules for performance reporting
1. PERFORMANCE REPORTING
1. Once performed, the health insurance company shall pay only one provider for one insured person.
2. If the name of the performance, the description of the performance, the chapter of the Additional Rules for the reporting of the performance or the limitation of the frequency for the performance is not otherwise stated, the health insurance company shall only pay the individual performance for one insured person to one provider on one day. The work carried out on the couple's organs shall be paid twice by the health insurance company for one insured person on one day, provided that it has been carried out on both sides, both on the right and on the left, unless otherwise specified in the performance. The performance performed on individual teeth shall be paid by the health insurance company for one insured person on one day once per tooth on which the performance was performed.
3. Only if a new treatment occurs due to a sudden change in the state of health of the insured person (a new visit to the same doctor's office or a visit to the medical practitioner or emergency services with the insured person) can be used to account for the next treatment according to the services actually paid again.
4. Performance shall be paid by the health insurance company only if the full content of the performance has been fulfilled.
5. Any service paid which has been declared through the performance, including the medical insurance undertaking's treatment days, shall be properly documented in the health file (hereinafter referred to as the "documentation ') of the insured person. The entry in the documentation is an integral part of all performance.
6. The power may only be declared if it has been fully implemented. Compliance with the capacity of the holder indicated in the performance is not a condition for his recognition if the exercise has been carried out by a health professional who is entitled under other legislation.
7. The amount to be reported in column 060 of this row:
8. In one visit, one insured person may be subject to only one clinical examination of one expertise.
9. If the provider recognises at the same time two performances which cannot be reported together under the list of performance, the health insurance undertaking shall be entitled not to reimburse the performance declared unduly.
10. If more than one performance can be charged according to the performance list, it may be charged only as many times as the full execution time specified in the performance list has been filled. The time of initiation and the time of termination of these tasks is a necessary part of the patient's documentation. If the time of commencement and termination of execution cannot be clearly determined from the documentation, the health insurance undertaking shall pay the number one performance.
11. When reporting performance related to tissue and organ transplantation according to § 35a of Act No. 48 / 1997 Coll., on Public Health Insurance, as amended, the frequency limitation applies to each recipient.
2. AUTOR TRAINING
1. The author's expertise of the performance in question is expressed by the professional company which proposed the performance and is responsible for its professional content.
2. The list of performance of the author's expertise is not binding on the contractual relationship between the provider and the health insurance undertaking.
3. PERFORMANCE CATEGORIES
1. Performance with category P is fully covered by public health insurance.
2. The performance with category W shall only be covered by public health insurance if certain conditions are met, or its payment shall be limited to a maximum frequency, or, if necessary, only partially at the specified level and under the given conditions; the approval by the health insurance undertaking is not necessary in such cases.
3. Performance with category Z is covered by public health insurance only under certain conditions and after approval by the health insurance company.
4. LOCATION LIMITATIONS
1. Power with restricted location And it's only covered by public health insurance if it's done on an outpatient basis.
2. Performance with H restricted is covered by public health insurance only if it has been performed during hospitalisation or if the patient's health condition in the overnight care bed allows
3. Performance with a limited place S is covered by public health insurance only if it has been carried out at a specialised workplace.
4. Performance limited by SA is covered by public health insurance only if it has been performed in an outpatient capacity in a specialised workplace.
5. Performance restricted to SH is covered by public health insurance only if it has been performed during hospitalisation at a specialised place of work or if the patient's health status in the overnight bed care system so permits.
6. The performance for which the limitation is not specified by the place is covered by public health insurance without limitation by the place of implementation.
7. The performance restricted by the place of AOD shall be covered by public health insurance separately only if it has been performed in an outpatient manner. In case of performance for hospitalisation, the performance shall be aggregated to the treatment day.
8. The performance with the restriction of the place of SAOD shall be covered separately from public health insurance only if it has been performed in an outpatient capacity in a specialised workplace. In case of performance for hospitalisation, the performance shall be aggregated to the treatment day.
5. RESTRICTIONS ON FREQUENCY
The frequency limitation shall be based on one insured person, one or more time periods and one provider.
The rules for reporting performance over a period for which frequency limitations are specified are as follows:
Week: During a period of 7 days from the date of the last reporting of the performance, including that date, the performance shall not be reported more times than allows for the limitation of the frequency of the performance.
Month: During a period of 28 days from the date of the last declaration of performance, including that date, the performance shall not be deported more than the limit of the frequency of the power.
Quarterly, 3 months (e.g. 1 / 1 quarter or 1 / 3 months): During a period of 84 days from the date of the last reporting of power, including that date, the power shall not be reported more than the limit of the frequency of that power.
Semi-annual: During a period of 175 days from the date of the last reporting of the power, including that date, the power shall not be reported more than the limit of the frequency of the power in question.
Year: During a period of 350 days from the date of the last declaration of performance, including that date, the power shall not be reported more than once than allows for the limitation of the frequency of the power.
If the performance is reported by one provider per insured person more than allows for frequency limitation, the health insurance undertaking shall be entitled to pay the performance up to the level of frequency limitation unless the revision doctor decides otherwise.
6. COMPETENT PERFORMANCE
Four categories of performance carriers are listed in the performance reports. They're:
1. physician, dentist, pharmacist (1),
2. non-medical health professionals who are fit to exercise their profession without professional supervision after obtaining professional and specialised competencies (2),
3. non-medical health professionals who are fit to exercise their profession without professional supervision after obtaining professional competence (2),
4. Other professionals 2).
The performance shall specify the times of each carrier and their wage indices.
The wage indices shall express the level of qualification of the carrier.
Compliance with the capacity of the carrier used in the calculation is not a necessary condition for its reporting if the performance is carried out by a healthcare professional who is entitled to do so under other legislation.
6.1. Indices of doctors, dentists and pharmacists
For performance carriers - doctors, dental practitioners and pharmacists are determined 3 degrees of wage index. They're:
1. Index 1 - Performance intensity corresponds to the qualifications of a doctor, dentist or pharmacist with professional competence - symbol L1, index value 1,
2. Index 2 - performance performance is consistent with the qualifications of a doctor or pharmacist with professional competence to pursue the profession without professional supervision on the basis of the certificate of completion of the baseline strain - symbol L2, index value 1,8,
3. Index 3 - performance performance is consistent with the qualifications of a doctor, dentist or pharmacist with specialised competence, with special competence or special specialised competence - symbol L3, index value 3,5.
6.2. Indices of non-medical health professionals eligible for the profession of health psychologist, speech therapist, physiotherapist, radiological physicist, specialist in laboratory methods and in the preparation of medicinal products, biomedical engineer, expert in the protection and promotion of public health
6.2.1. Indexs of psychologists in health care
For performers - psychologists in health care are set 2 levels of wage index. They're:
1. Index 1 - Performance intensity corresponds to the qualification of a psychologist in a healthcare professional - symbol K1, value 1,
2. Index 3 - Performance performance is consistent with the qualification of a psychologist in health care with specialised competence or with specialised competence and professional competence or with other specialised competence - symbol K3, index value 3,5.
6.2.2. Indexs of logopeds in health care
For performance carriers - Jogopeds in health care are set 3 degrees of wage index. They're:
1. Index 1 - performance performance performance is consistent with the qualification of the speech in health - symbol K1, index value 1,
2. Index 2 - performance performance is consistent with the qualification of the clinical logotype - symbol K2, index value 2,5,
3. Index 3 - Performance performance is consistent with the qualification of a clinical speech with special competence - symbol K3, index value 3,5.
6.2.3. Indices of visual therapists
For performance carriers - visual therapists are determined 3 degrees of wage index. They're:
1. Index 1 - performance performance is consistent with the qualification of the visual therapist - symbol K1, index value 1,
2. Index 2 - performance performance is consistent with the qualification of a visual therapist with specialised competence - symbol K2, index value 2,5,
3. Index 3 - performance performance is consistent with the qualification of a visual therapist with specialised competence and special competence - symbol K3, index value 3,5.
6.2.4. Indices of physiotherapists
For performance carriers - physiotherapists are determined 3 degrees of wage index. They're:
1. Index 1 - Performance performance is consistent with the qualification of a physiotherapist with professional competence to perform a medical profession under professional supervision or direct guidance (ZPOD) - symbol K1, index value 1,
2. Index 2 - performance performance is consistent with the qualification of a physiotherapist with professional competence to perform a medical profession without professional supervision (ZPBD) - symbol K2, index value 2,5,
3. Index 3 - performance performance is consistent with the qualification of a physiotherapist with specialised competence - symbol K3, index value 3,5.
6.2.5. Indices of health professionals of radiological physics, specialist in laboratory methods and in the preparation of medicinal products, biomedical engineer, expert in the protection and promotion of public health
For the carriers of the performance of health professionals - radiological physics, specialist in laboratory methods and in the preparation of medicinal products, biomedical engineer, professional worker in the protection and promotion of public health are set 2 levels of wage index. They're:
1. Index 1 - symbol K1, index value 1; the performance performance is consistent with the qualification of the profession with competence to perform it, for:
(a) radiological physics;
(b) an expert in laboratory methods and in the preparation of medicinal products;
(c) biomedical engineer,
(d) an expert in the protection and promotion of public health.
2. Index 2 - symbol K2, index value 2,5; the performance performance is consistent with the qualification of a profession with a specialised competence or specific competence to pursue it, for:
(a) radiological physics;
(b) an expert in laboratory methods and in the preparation of medicinal products;
(c) biomedical engineer,
(d) an expert in the protection and promotion of public health.
6.3. Indices of other non-medical health professionals
6.3.1. Indexs of non-medical health workers
For performance carriers - non-medical health professionals (NLZP), 3 levels of wage index have been established. They're:
1. Index 1 - Performance performance is consistent with the qualifications of a healthcare professional qualified to pursue a medical profession under professional supervision or direct guidance (ZPOD) - symbol S1, index value 1,08,
2. Index 2 - Performance performance is consistent with the qualifications of a healthcare professional who is qualified to perform a medical profession without professional supervision after obtaining professional competence (ZPBD) - symbol S2, index value 1,8,
3. Index 3 - Performance performance is consistent with the qualification of a health professional qualified for the health profession without professional supervision who have further acquired specialised competence in the relevant field (ZPBD) or special competence - S3 symbol, index value 2,25.
6.3.2. Adictologist indices
For performance carriers - adictologists are determined 2 degrees of wage index. They're:
1. Index 2 - performance performance is consistent with adictologist qualification - symbol S2, index value 1,8,
2. Index 4 - performance performance is consistent with the qualification of an adictologist with higher education with specialised competence in the relevant field or special competence - symbol S4, index value 2,5.
6.3.3. Indices for non-medical health professionals providing health care in the patient's own social environment
For performance carriers - non-medical health professionals providing health care in the patient's own social environment within the scope of expertise 925 - home care are determined by 3 levels of wage index. They're:
1. Index 1 - Performance performance is consistent with the qualifications of a healthcare professional qualified to pursue a professional profession (ZPOD) - symbol D1, index value 1,08,
2. Index 2 - performance performance is consistent with the qualifications of a health professional qualified to perform a health profession without professional supervision (ZPBD) - symbol D2, index value 1,8,
3. Index 3 - Performance performance is consistent with the qualifications of a healthcare professional qualified to pursue a medical profession without professional supervision with specialised competence in the relevant field or special competence - symbol D3, index value 2,25.
6.4. IBP Indexs
(3) A single wage index is set for the performers of other professional works3):
1. Index 1 - Performance performance is consistent with the rating of the JOP - symbol J1, index value 1.
6.5. Basic minute rate of performance carriers
(a) The basic minute rate for power carriers L1, L2, L3, K1, K2, K3, J1 and S4 shall be 3,9946 points, for power carriers S1, S2, S3 shall be 2,3795 points and for power carriers D1, D2 and D3 shall be 3,2121 points.
(b) For the purposes of calculating the number of points of power, the basic minute rate of power carriers shall be multiplied by the relevant wage index referred to in the chapter and rounded to four decimal places.
(c) The basic minute rate of performance carriers shall be calculated by adding to the current value the average annual inflation rate, measured by the consumer price index, for the past calendar year published by the Czech Statistical Office. The calculated base minute rate of the power carriers shall be rounded to four decimal places and shall apply from 1 January to 31 December of the following calendar year.
6.6. Point value and rounding rules
The point value of power shall be determined as follows:
* * * * * * Msi * ČNi + ČV * Ro + P
where
i gets values and up to n, where and up to n are the performance carriers
i value of the power carrier index i
Msi basic minute rate of the power carrier i
Article time of the power-holder i
ČV time of execution
Ro minute overhead rate allocated to the performance of the expertise
P direct costs, which include the sum of the costs of single-purpose devices and their specific maintenance, when performing directly consumed medical material and when performing directly consumed medicinal products
The personnel costs of the performance carriers I * MS * ČN are rounded to two decimal places.
The overheads of performance (CV * Ro) shall be rounded to two decimal places.
Direct performance costs, which include the sum of the costs of single-purpose devices and their specific maintenance, when performing directly consumed medical material and when performing directly consumed medicinal products, shall be rounded to two decimal numbers.
The resulting point value of power shall be rounded to the integer after the sum of direct, personal and overheads.
7. ZUM AND ZULP
7.1. Reporting ZUM
1. A separately charged material may only be declared for execution if the "ZUM yes' note is given for the performance.
2. As separately charged material (ZUM), only material clearly consumed may be declared for execution.
3. If the material is not consumed whole, the proportional part of it may be reported for execution.
7.2. Reporting of ZULP
1. A specifically charged medicinal product may only be declared for performance if the "ZULP yes' endorsement is provided for performance.
Transfusion products, blood derivatives and radiopharmaceuticals may be reported as ZULP, whether or not the entry "ZULP yes" in performance.
3. As a specifically charged medicinal product, only a medicinal product clearly consumed may be declared for performance.
4. If the medicinal product is not consumed whole, the proportional part of the medicinal product must be reported for performance.
7.3. As ZUM or ZULP, it cannot be reported:
1. Medicinal products, medical supplies and medical devices that can be prescribed for a prescription or voucher.
2. Medicinal products and medical material included directly in the power value (PMAT and PLP) or aggregated into the treatment day or performance of clinical examinations.
3. Medicinal products covered by the flat-rate.
4. Medicinal products, medical supplies and medical devices obtained other than by purchase (pharmacological studies, corporate, research grants, sponsorship gifts, etc.)
8. TYRES ("HOSPITALISATION")
8.1. Acceptance to hospitalization
When an insurer is admitted to hospital, the performance of a comprehensive examination of the relevant expertise shall be reported. If the insured person has been hospitalised with that provider within the last three months prior to admission and has been declared at the time of admission for a clinical examination of that expertise, or if the insured person has been declared at that provider during the 24 hours prior to admission for hospitalisation for performance No 06726 COMPLEX INVESTIGATION BY URGENT REVENUE, only targeted examinations may be reported.
8.2. Discharge from hospitalization
A targeted examination of the relevant expertise shall be reported when the insured person is released from the hospital.
9. VISITS
A record in the documentation indicating the date and time of the visit shall be a condition for reporting the visit.
9.1. Visits of a physician in a patient
Visits by a doctor to a patient are shown in special procedures. In addition to these performances, the performance of clinical examinations and other performance according to the applicable rules shall be reported.
Visiting a physician in a patient may be shown by the following procedures:
1. Visiting a physician in a patient
2. Visiting a doctor between 19 and 22 hours
3. Visiting a doctor between 22 and 06 hours
4. Visiting a doctor on the day of work or on the day of work
The above performance may be combined in addition to those referred to in points 2 and 3.
9.2. Visits of specialists in patients
In addition to a physician, psychiatrist or clinical psychologist, a visit to a patient may also be made by another attending physician, but only if the visit is made at the written request of the physician. In the case of a visit between 19 and 06 hours or on the day of work and rest, the application shall include the date and time of the visit.
Visiting a doctor in a patient may be shown by the following procedures:
1. Visiting a specialist in a patient
2. Visiting a doctor between 19 and 22 hours
3. Visiting a doctor between 22 and 06 hours
4. Visiting a doctor on the day of work or on the day of work
The above performance may be combined in addition to those referred to in points 2 and 3.
The performance of a specialist's visit to the patient shall be borne by the health insurance company only if the visit is requested by a physician, except by a psychiatrist or a clinical psychologist. This performance can also be reported when visiting a specialist in a social services residence or similar environment, but only per person in one day.
9.3. Visiting a physiotherapist, general nurses, psychiatric care nurses, children's nurses and midwives
Visiting a physiotherapist, general nurses, psychiatric care nurses, children's nurses and midwives are shown to perform copyright 902, 911, 914, 921 and 925.
A visit to a general nurse, physiotherapist, psychiatric care nurse, pediatric nurse and midwife shall be reported on the basis of a written indication from the attending physician.
Proceedings Nos 06135 and 06645 may be reported together with the performance performed only if it has been performed on the basis of a written indication from the treating physician. This indication always contains the date and time of execution in this case.
Proceedings Nos 06137 and 06649 may be reported together with the performance performed only if performed on the basis of a written indication from the treating physician. This indication always contains the date of performance in this case.
9.4. Time spent by transport
The time of the doctor spent on the patient's visit can be reported every 10 minutes. At 1 km distance can be reported at most 2 minutes time.
10. ADMINISTRATIVE EXPENDITURE
10.1. The detailed statement of documentation shall be reported:
the activity of the registrant associated with the acquisition of the extract from the documentation when transferring the patient to the care of another registrant.
10.2. Performance content The detailed extract from the documentation is mainly:
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Regulation Information
| Citation | Decree of the Ministry of Health No. 134 / 1998 Coll., which publishes a list of health performance with points |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 24.06.1998 |
|---|---|
| Effective from | 01.07.1998 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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