Decree No 493 / 2005 Coll.
Decree amending Decree No. 134 / 1998 Coll., published a list of health performance with points, as amended
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01.01.2006
22.12.2005
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493
DECLARATION
of 9 December 2005
amending Decree No. 134 / 1998 Coll., which publishes a list of health performance with points, as amended
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 Annex to Decree No. 134 / 1998 Coll., which publishes the list of health performance with point values, as amended by Decree No. 55 / 2000 Coll., Decree No. 135 / 2000 Coll., Decree No. 449 / 2000 Coll., Decree No. 101 / 2002 Coll. and Decree No. 291 / 2002 Coll., reads:
"Attachment 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 výkonu s bodovými hodnotami |
| 2. | zdravotní výkon | základní jednotka seznamu, popisující ucelenou činnost při poskytování zdravotní péče (dále jen výkon) |
| 3. | kategorie výkonu | kategorie úhrady výkonu - řadí výkon mezi výkony plně hrazené, hrazené za určitých podmínek a nehrazené z veřejného zdravotního pojištění |
| 4. | autorská odbornost | odbornost, která navrhla a odborně garantuje zdravotní 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 místem jeho provedení |
| 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 středních zdravotnických pracovníků Osou 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. | body bodová hodnota výkonu | součet všech přímých nákladu na výkon (osobních nákladu nositele výkonu, nákladů na jednoúčelové přístroje a jejich specifickou údržbu, při provedení výkonu přímo spotřebovaný zdravotnický materiál a při provedení výkonu přímo spotřebované léčivé přípravky) kalkulovaný v korunách a 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 |
Chapter 2
General rules for performance reporting
1. PERFORMANCE REPORTING
1. Once performed, the health insurance company pays only one health care institution for one insured person.
2. If the name of the performance, the description of the performance, Chapter Other rules for reporting the performance or the limitation of the frequency of the performance are not otherwise stated, the health insurance company shall only pay the individual performance for one insured person to one health institution 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 health status of the insured person (a new visit to the same doctor's office or a visit to the medical practitioner or to the LSPP to the insured person), the corresponding performance can be used according to the actual care provided.
4. Performance shall be paid by the health insurance company only if the full content of the performance has been fulfilled.
5. All health care that has been reported through the health performance of the health insurance undertaking must be properly documented in the health documentation of the insured person. The entry in the documentation is an integral part of all health performance.
6. The power may only be declared if it has been fully implemented. The partially executed performance cannot be reported to the health insurance undertaking.
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. Where a health care institution reports at the same time two performances that 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 an essential part of the patient's medical 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 every donor.
2. AUTOR TRAINING
1. The author's expertise of the health performance is expressed by the professional company which proposed the health 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 health care institution 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 Q is covered by public health insurance only if it is not declared together with the performance of complex, repeated complex, targeted or control tests.
3. Performance with category W is covered by public health insurance under certain conditions. Unless otherwise stated in the performance, this condition is to perform the performance from a health indication.
4. Performance with category Z is covered by public health insurance with the agreement of the medical examiner of the relevant 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 restricted to H is covered by public health insurance only if it has been performed during hospitalisation.
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 limited to SH's place is covered by public health insurance only if it has been carried out during hospitalisation at a specialised workplace.
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.
5. RESTRICTIONS ON FREQUENCY
The frequency limitation is based on one insured person, one or more periods of time and one medical facility.
If the performance is reported by one health care institution per insured person more frequently than specified in the frequency limitation, the health insurance undertaking shall be entitled to pay the performance up to the frequency limitation limit, unless the medical examiner decides otherwise.
6. COMPETENT PERFORMANCE
Four categories of performance carriers are included in the performance. They're:
1. physician, dentist, pharmacist 1)
2. clinical psychologist, clinical logoped and university-educated physiotherapy ut2)
3. another university-educated worker in medical2)
4. Median Medical Worker 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.
Proceedings carried by another university-educated health worker may also be performed by an appropriately qualified doctor.
Compliance with the capacity of the carrier used in the calculation is not a necessary condition for the performance of a particular medical establishment.
6.1. Physician's Indices
Three stages of the wage index are set for the performance-doctor. They're:
1. Index 1 - performance performance is consistent with the qualifications of a doctor, dentist or pharmacist with professional qualifications and experience within 24 months - symbol L1, index value 1
2. Index 2 - performance performance is consistent with the qualifications of a doctor, dentist or pharmacist with professional competence and experience over 24 months - symbol L2, index value 1,8
3. Index 3 performance performance is consistent with the qualification of the physician, dentist or pharmacist with specialised competence - symbol L3, index value 3,5
6.2. Indexs of clinical psychologists, clinical loops and university-educated physiotherapists
For performance carriers - clinical psychologists, clinical loopeds and university-educated physiotherapists, four levels of wage index are established. They're:
1. Index 3 - Performance performance is consistent with the qualification of a clinical psychologist with completed special training in clinical psychology and tests, clinical speech with completed special training in clinical loopedia and / or medical practitioner with other higher education in physiotherapy - symbol J1, index value 1
2. Index 4 - Performance performance performance is consistent with the qualification of a clinical psychologist with completed special training in clinical psychology and / or clinical speech with completed special training in clinical speech and diagnostic and therapeutic procedures - symbol J 1, index value 1,3
3. Index 5 - Performance performance is consistent with the qualification of a clinical psychologist with athesis in clinical psychology with additional qualifications or defined duration of practice or clinical logopeda with an athesis in clinical logology with additional qualifications or defined duration of practice - symbol J1, index value 1,8
4. Index 6 - Performance intensity corresponds to the qualification of a clinical psychologist with an athesis in a clinical psychology with an exceptional qualification and a defined duration of practice or clinical speech with an athesis in an exceptional qualification and a specified duration of practice - symbol J1, index value 3,0
6.3.
For performance holders - other university-educated health workers (JSC), five grades of wage index are set. They're:
1. Index 1 - Performance intensity corresponds to the JSC qualification after graduation - symbol J0, index value 0,5
2. Index 2 - Performance performance is consistent with JSC qualification with practice 24 months - symbol J0, index value 0,8
3. Index 3 - Performance intensity corresponds to the JSC qualification with completed special training in the relevant section of activity and tests - symbol J1, index value 1,0
4. Index 4 - Performance performance is consistent with the JSC qualification with completed special training in the relevant field of activity of tests and 5 years of experience in the medical facility - symbol J1, index value 1,3
5. Index 5 - Performance intensity corresponds to the JSC qualification with completed special training in the relevant field of activity of tests and 10 years of experience in the medical facility - symbol J2, index value 1,8
6.4. CAP Indices
Three stages of the wage index have been established for performance carriers - medium health professionals (PMI). They're:
1. Index 7 - Performance intensity corresponds to the PMI qualification until completion of the starting practice - symbol S1, index value 0,6
2. Index 8 - Performance intensity corresponds to the PMI qualification after completion of the entry rule-symbol S2, index value 1,0
3. Index 9 - Performance intensity corresponds to the PMI qualification after completion of the PSS (S3 symbol, index value 1,4)
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.
(2) Blood and 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 may be declared for performance.
7.3. As ZUM or ZULP, it cannot be reported:
1. Medicinal products, special medical supplies and medical devices that can be prescribed for a prescription or voucher.
2. Medicinal products and special 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, special medical supplies and medical devices obtained by means other than purchase (pharmacological studies, corporate, research grants, sponsorship gifts, etc.)
8. CONSTRUCTION PRESENT (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 in that establishment within the last three months prior to admission and has been declared to have carried out a clinical examination of this expertise upon receipt, 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, a doctor may also report a visit to a doctor, but only if a visit is made at the written request of a physician registering a patient. 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 practitioner. This performance can also be reported when visiting a specialist in a social care institution or similar environment, but only per capita in that institution in one day.
9.3. Visiting Sisters
A nurse's visit is reported to be performance of the 911 author's expertise.
9.4. The exercise of the nurse between 22 and 06 hours and the exercise of the nurse on the day of work leave or on the day of work leave may be reported together with the performance performed only if it has been performed on the basis of a written indication by the physician. This indication shall always include the date and time of execution in this case. Visiting experts 902 and 918
Proceedings shall be reported on the basis of a written indication by the treating physician and a certificate by the registering physician.
9.5. 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 registered doctor associated with the receipt of the extract from the medical file when transferring the patient to the care of another registrant.
10.2. Performance content The detailed extract from the documentation is mainly:
1. study patient medical documentation
2. the acquisition of a copy of the documentation or extract from the documentation to the extent necessary to ensure the continuity of medical preventive care
3. Sending an extract to the newly registered physician
10.3. The performance of the administrative action of a practitioner shall show:
the activity associated with preventive, dispensary, diagnostic or therapeutic care, provided that it is carried out without clinical examination of the patient and that it is not a consultation of a practitioner by family members.
In addition to the performance, a detailed statement of the documentation and the administrative actions of the practitioner shall not be reported on the same day.
11. MINIMUM CONTACT
11.1. The minimum contact shall be reported:
Contact of a physician, clinical psychologist or clinical speech surgeon with a patient prior to diagnostic or therapeutic performance, unless the control examination has been completed.
11.2. The minimum contact is the content of the power:
1. a history of following diagnostic or therapeutic care
2. assessment of subjective difficulties in relation to subsequent diagnostic or therapeutic care
3. decision on the date of further inspection
4. provision of adequate information to the sick, family or legal representative
5. writing medical report - finding
6. administrative activity associated with the performance (issue of a certified work of an incapacitated insured person, application for support in the treatment of a sick family member, proof of permanent incapacity, compulsory reporting, etc.)
7. entry of the entire procedure into the health file
12. TELEPHONE CONSULTATION
By performing a telephone consultation by a doctor, the patient can only be reported telephone contacts between the patient and the doctor if it is directly related to prevention, dispenzarisation, diagnosis or therapy.
This performance may be reported if the patient actively contacts the doctor, even if the doctor actively contacts the patient, even if there is telephone contact between the doctor and the family members or legal representatives of the patient or other caregivers.
Only the attending physician may report the conduct of the telephone consultation by the physician. If the treating physician is not a registering physician, he may only report this performance if it is directly related to the problem for which he has taken care of the patient.
Different performance of telephone information is defined for psychiatric fields.
13. LSPP
During the first-aid medical service, physicians report clinical examinations of expertise 001, 002 and 014, depending on the patient's age. If the patient is under 18 years of age, the performance of the expertise is 002, in other cases the performance of the expertise 001.
It also shows all actual and in full performance while respecting the rules in force.
During the first aid medical service, the performance of a comprehensive and repeated comprehensive examination cannot be reported.
_
Domestic health care activities are reported by health care institutions providing domestic health care.
Domestic health care activities can only be reported
1. in the indication of a registering physician or a registering physician for children and adolescents
2. in the case of an indication by the treating physician during hospitalisation, for a period of not more than 14 days after completion of hospitalisation.
The regulation of home health care, registered by a practitioner or a practitioner for children, shall be valid for a maximum of 1 month.
15. PERFORMANCE OF STATIM
If the doctor indicates that the performance is performed immediately (the static), the entry in the medical documentation is an integral part of this indication. Performance is indicated only for health reasons not for technical organisation.
Chapter 3
Clinical examination procedures
The performance of clinical examinations is the basic performance by which health care institutions report health care to health insurance companies provided to insured persons.
Clinical examinations shall be divided into complex examinations, repeated complex examinations, targeted tests, control tests and consul tests.
According to individual authorial expertise, material and instrumentation costs of performance aggregated into clinical examinations are aggregated into the performance of clinical examinations. These are performances for which the "Q - cannot be reported with clinical examination 'is indicated in the performance category list.
1. REPORTING OF CLINICAL INVESTIGATION
1. Only one of the results of the clinical trials may be reported during one visit.
2. The performance of clinical examinations cannot be combined with administrative and telephone information.
3. For authors who have multiple clinical examinations, the reporting physician shall use the performance corresponding to his / her competence.
4. Clinical examinations can be combined with visitor service.
2. COMPLEX INVESTIGATION
2.1. The performance of a comprehensive examination shall be reported:
1. examination of the patient when taking care of a practitioner, practitioner for children and youth, gynecologist - obstetrician and practitioner
2. examination of the patient when taking over into regular long-term care of an outpatient specialist
3. examination of the patient when receiving hospitalization if hospitalisation has not been preceded by hospitalisation in the same workplace in the last three months
2.2. The content of the performance of the complex examination is mainly:
1. detailed personal history including family, work and social history
2. assessment of subjective difficulties
3. evaluation of previous clinical, laboratory and imaging examinations
4. general objective examination, in general physicians, internal and surgical fields including perrectum
5. Measurement of height, weight, blood pressure, pulse, breath rate, or rate of exhalation by the peakflowmeter
6. basic indicative preventive oncological examination
7. diagnostic balance sheet and conclusion
8. decision on further diagnostic procedure, including the request of further clinical, laboratory or imaging examinations
9. Decision on therapeutic procedure, including prescription of drugs or ZP
10. small therapeutic performance
11. decision on the date of further inspection
12. provision of adequate information to the sick, family or legal representative
13. psychotherapy interview
14. Individual health education
15.
16. medical report - finding
17. administrative activity associated with the performance (issue of the ID of the incompetent insured person's work, request for support in the treatment of a sick family member, proof of the duration of the incapacity for work, compulsory reporting, medical transport requisition, etc.), provision of information to the practitioner, including a record of patient consent or disagreement with the proposed diagnostic - therapeutic procedures
18. entry of the whole procedure into the health file
3. REPEATED COMPLEX INVESTIGATION
A repeat comprehensive examination may be reported only by an adult physician, a adult practitioner and a young and a dental practitioner.
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Regulation Information
| Citation | Decree No 493 / 2005 Coll., amending Decree No. 134 / 1998 Coll., which publishes a list of health performance with points, as amended |
|---|---|
| Regulation Type | Order |
| Author | - |
| Collection | Code of Laws |
| Date of Promulgation | 22.12.2005 |
|---|---|
| Effective from | 01.01.2006 |
| Effective until | - |
| Status | Valid |
The regulation text is for informational purposes only.
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