9 Calculating the fee for persons covered by statutory health insurance and those entitled to medical care 8

Transcription

1 General Conditions of Contract (AVB) for the University Hospital of Würzburg Status: 1st January 2010 Table of contents 1 Applicability 2 2 Definitions 2 3 Legal relationship 4 4 Scope of the hospital services 4 5 Additional services 5 6 Admission, transfer, discharge 6 7 Inpatient and post-inpatient treatment 7 8 Fees 8 9 Calculating the fee for persons covered by statutory health insurance and those entitled to medical care 8 10 Calculating the fee for self-pay patients 8 11 Invoicing 9 12 Advance payments, partial payments 9 13 Leave of absence Medical intervention Post-mortem examination Recording of data House rules Internet access Patient belongings Liability restriction Place of payment Coming into force 13 1

2 General Conditions of Contract (AVB) for the University Hospital of Würzburg 1 Area of applicability Provided nothing else has been agreed, the AVB apply to the contractual relationship between the University Hospital of Würzburg and the patient in the case of full inpatient and partial inpatient as well as inpatient and post-inpatient hospital services. 2 Definitions As defined by these AVB: 1. Treatments: a) all services which are determined to establish, heal or alleviate illnesses, suffering or personal injury, b) services for childbirth, c) examinations for evaluation purposes. 2. General hospital services: General hospital services are hospital services which, whilst considering the capabilities of the hospital and based on the nature and severity of the illness of individual cases, are considered necessary for the medical practicable and sufficient treatment for the patient. The conditions for these include: a) the services carried out during the hospital stay based on the early detection of illnesses as defined in the fifth volume of the German Social Code (SGB V), b) third-party services arranged by the university hospital, c) necessary admittance of an escort for the patient for medical reasons, d) the special services of tumour centres and oncological areas for the inpatient care of patients suffering with cancer, e) early rehabilitation as defined in 39 par. 1 clause 3 SGB V. 2

3 3. Additional services: These are services of the university hospital which the responsible authorities deem to be separately chargeable services in accordance with 17 KHG (Krankenhausfinanzierungsgesetz) / (Law on Financing of Hospitals), KHEntgG (Krankenhausentgeltgesetz) / (Hospital Tariff Legislation) and BPflV (Bundespflegesatzverordnung) / (German Ordinance on Hospitalisation Cost Rate) in their respective valid versions. 4. Third-party services: a) services of consultants (no. 5) or other persons who have no employee relationship (no. 10) with the university hospital, b) services from facilities which have no operational, financial or organisational involvement with the university hospital. 5. Consultants: Doctors and dentists who have no employee relationship (no. 10) with the university hospital and are brought in in a consulting, examining or treating capacity. 6. Payers: Natural or legal persons who owe the university hospital the fee for the services rendered. 7. Members of statutory health insurance schemes: Patients for whom a social insurance carrier, a welfare organisation or a responsible authority owe the fees for the general hospital services. 8. Patients entitled to medical care: Patients for whom, due to a legal claim for treatment; a body, institute or foundation under public law owes the fees for the hospital services 9. Self-pay patients: Patients who are not covered by statutory health insurance or are not entitled to medical care or who avail themselves of services as persons who are covered by statutory health insurance or are entitled to medical care, who are not covered by a health insurer s agreement to cover costs. 10. Employment circumstances: all employment, civil servant and training contracts. 3

4 11. Intercurrent diseases: Illnesses which do not associate themselves with the original illness for which the patient is in the hospital and the immediate treatment of which is not necessary in order to achieve a healing success. 3 Legal relationship (1) The legal relationships between the hospital and the patient are of a civil law nature. (2) The AVB applies to the patient if he: is expressly if it is comparatively difficult to make an express reference, due to the nature of the conclusion of contract informed of this by means of a clearly evident notice at the location of the conclusion of contract, has been able to read the content in a reasonable manner, and ensuring the user of the AVB has taken into consideration any bodily impediments of the other contractual party, has declared that he agrees to their application. (3) The regulations of these AVB regarding the rights and obligations of the patient, also apply to the payers, provided this does not concern rights or obligations which are being or will be perceived personally by the patient. 4 Scope of the hospital services (1) The full inpatient, partial inpatient as well as inpatient and post-inpatient services of the University Hospital of Würzburg (hospital services) include: a) the general hospital services, b) the additional services. (2) The contractual offer of the University Hospital of Würzburg covers only those services for which it is equipped in terms of personnel and equipment for its medical objectives. (3) Not included under general hospital services are: a) dialysis, if a respective treatment is being continued using this, as the hospital does not own dialysis equipment and it does not form the basis of the principle hospital treatment, b) devices, which the patient is given at the end of the university hospital stay (e.g. orthopaedic devices), c) autopsy, post-mortem examination, as well as issuing a death certificate, d) services which, according to a decision reached by the Federal Joint Committee in accordance with 137c SGB V, will not be provided at the expense of the statutory health insurance. 4

5 5 Additional services (1) Provided the general hospital services are not negatively affected in any way, the following additional services can be agreed and invoiced for separately between the university hospital and the patient (within the means of the university hospital as well as in accordance with these AVB, the conditions (cf. DRG fee tariff in the application area of the KHEntgG and the BPflV) as well as the separate patient information for additional services patients): a) The medical services of all the doctors of the university hospital who are participating in the treatment, provided these are authorised to separately invoice for their services or the university hospital has authorised that these services may be invoiced for separately, including the services of doctors or medical facilities outside of the university hospital which have been arranged for by these doctors, b) Accommodation in a single room, c) Accommodation in a double room, provided this is not a standard benefit, d) Special watch, e) Accommodation and board for a requested escort. (2) In the case of childbirth, additional services requested by the mother do not cover the healthy newborn baby. The healthy newborn baby requires a separate additional services agreement. (3) Separately calculated medical services as defined in par. 1 clause a), also provided they are calculated by the university hospital, are provided by the director of a hospital, the chairman of an institute or the head of an independent department himself or are provided by a subordinate doctor who is following professional instructions and acting under his supervision ( 4 par. 2 GOÄ/GOZ). If the managing doctor (director of a hospital, chairman of an institute or head of an independent department) cannot attend, his permanent medical representative will undertake the task. (4) Additional services must be agreed in writing before they are provided. (5) The university hospital reserves the right to refuse the conclusion of an additional services agreement for patients who have previously violated medical or care arrangements or the house rules or did not pay / paid significantly late for a previous treatment. (6) The university hospital can immediately initiate additional services if these are considered necessary for the fulfilment of the general hospital services for other patients. 5

6 6 Admission, transfer, discharge (1) Within the framework of the efficiency of the hospital, persons requiring full inpatient or partial inpatient hospital treatment will be admitted. The order of admission is based on the severity and urgency of the case. (2) Those requiring immediate treatment due to a danger of life or danger of an impending worsening of their illness (emergency), will be admitted for the time being even if the qualitative or quantitative efficiency of the university hospital is not given until they can be transferred to another suitable hospital. (3) An escort will be admitted if this is considered medically necessary for the treatment of the patient and it is possible to accommodate them in the university hospital, whereby the director of the hospital or his representative will establish whether or not this is medically required. In addition to this, upon the application of the patient for additional services ( 5), an escort may be admitted if there are sufficient accommodation options available, the running of the hospital is not hindered in any manner and there are no medical reasons which would counter such a decision. (4) For reasons of medical necessity (especially in the case of emergencies), patients can be transferred to a different hospital. The transfer will be discussed with the patient before hand if this is possible. If a transfer is not urgently required for medical reasons, in accordance with 60 SGB V (assumption of transport costs), a transfer to a hospital in the vicinity of the patient s residence (at the request of the patient who is covered by statutory health insurance and at the expense of the statutory health insurance), is dependent on the consent of the statutory health insurance to pay a flat rate payment. If the statutory health insurance refuses this consent, the transfer will only take place at the express wish and expense of the patient who is covered by statutory health insurance. The hospital will inform the patient who is covered by statutory health insurance of this. (5) Discharge will be granted if a) the treating doctor considers it no longer necessary for the full inpatient or partial inpatient to receive treatment, b) the discharge is expressly requested. If, against medical advice, the patient insists on his discharge or leaves the university hospital of his own accord, the university hospital will not be held liable for the consequences. An escort will be discharged if the conditions in accordance with paragraph 3 no longer apply. (6) If no post-inpatient hospital treatment is initiated, the treatment contract obligations of the university hospital end upon discharge. 6

7 7 Inpatient and post-inpatient treatment (1) If medically suitable, upon the decree of the hospital treatment (hospital referral), the university hospital may treat patients without providing accommodation and board, in order to: a) clarify the necessity of a full inpatient hospital treatment or prepare for the full inpatient hospital treatment (inpatient treatment), b) ensure or establish the success of the treatment after a full inpatient hospital treatment (postinpatient treatment). (2) The inpatient hospital treatment, which may not exceed three treatment days within five calendar days from the start of the inpatient treatment, ends a) upon admission of the patient into full inpatient treatment, or b) if it transpires that a full inpatient hospital treatment is not required or is only required outside of the inpatient timeframe, or c) if the patient expressly requests the conclusion or aborts the treatment. In cases b) and c), the treatment contract also expires. (3) The post-inpatient hospital treatment, which must not exceed the seven treatment days within fourteen calendar days, in the case of organ transplants in accordance with 9 of the Transplantation Act, three months after the end of the inpatient hospital treatment, ends: a) if the hospital doctor considers the treatment to have been a success or established, or c) if the patient expressly requests the conclusion or aborts the treatment. The treatment contract ends simultaneously. In medically-justified individual cases, the period of 14 calendar days or 3 months may be extended by arrangement with the referring physician. Check-up examinations in the case of organ transplants, in accordance with 9 of the Transplantation Act, may be continued also after the conclusion of the post-inpatient treatment in order to scientifically accompany or support the further hospital treatment or measures of quality assurance. (4) The hospital will inform the referring physician punctually of the inpatient and post-inpatient treatment of the patient as well as inform him, and the other physicians involved in the further treatment, about the check-up examinations and their results. A necessary medical treatment outside of the university hospital during the inpatient and post-inpatient treatment will be provided by the registered doctors and is not considered part of the hospital services. 7

8 8 Fees The fees for the services of the university hospital are based on the legal provisions and the DRG fee tariff in the application area of the KHEntgG and the BPflV in the respective valid version which is a constituent part of these AVB. If hospital services are invoiced for using diagnosis-orientated flat rate payments (Diagnosis Related Groups DRG), the concrete fees are measured on the individual circumstances of the case (main diagnosis, executed procedures, secondary diagnoses, degree of severity, basic case value etc.). For Germany, the assessment basis is the currently valid DRG system alongside the associated billing rules. 9 Calculating the fee for persons covered by statutory health insurance and those entitled to medical care (1) If, in accordance with the respective valid legal provisions, a public or private law sponsor (e.g. health insurance company etc.) is obliged to pay the fee for the hospital services, the hospital will settle its fees immediately with this health insurance company. Upon the request of the hospital, the patient will submit an agreement to cover costs from his sponsor, which includes all the services necessary for medical care in the hospital within the framework of the specific case (depending on the nature and severity of the illness). (2) If the patient is not furnished with such an agreement to cover costs or if it does not sufficiently cover the services which are being used (e.g. additional services), then the patient, as a self-pay patient, is obliged to pay the fee for the services ( 10). (3) In accordance with 39 par. 4 in the fifth volume of the German Social Code, members of statutory health insurance schemes who have attained the age of eighteen, are obliged to make an additional payment from the start of the full inpatient hospital treatment within one calendar year. (4) Members of statutory health insurance schemes where a hospital treatment is being carried out in accordance with 39 par. 4 SGB V, and who declare that they wish to be informed of the services provided by the hospital as well as how much the health insurance scheme has paid for these services, will receive written information in this regard within four weeks after the conclusion of the hospital treatment, and they or their legal representative have up to two weeks after the conclusion of the treatment to explicitly request this from the hospital administration. 10 Calculating the fee for self-pay patients (1) Patients who are not covered by statutory health insurance or are not entitled to medical care or who avail themselves of services as persons who are covered by statutory health insurance or are entitled to medical care, who are not covered by a health insurer s agreement to cover costs, are obliged, as self-pay patients, to pay the fee for the services. 8

9 (2) Should the patient, as a person insured with a private health insurance scheme, make use of the option of a direct statement between the hospital and the private health insurance company, the invoices will be issued directly to the private health insurance company. The condition for a direct invoicing of this nature is that the insured party declares in writing his consent (which can be revoked at any time) for the necessary data to be passed on to the private health insurance company. 11 Invoicing (1) Interim invoices can be drawn up for hospital services. After the conclusion of the treatment, a final invoice is drawn up. (2) Subject to the subsequent billing of invoices which are not included in the final invoice and the reporting of errors. (3) The invoice amount will be payable by the date specified on the respective invoice or otherwise immediately upon receipt. (4) In the event of a delayed payment, interest to the amount of 5% above the respective base interest rate of the European Central Bank will be added; in addition to this, reminder fees at the amount of 6.00 Euro per reminder will be charged, unless the patient can prove that no damage or an essentially smaller damage has occurred. (5) It is not permitted to deny payment to set off against other invoices that are in dispute. 12 Advance payments, partial payments (1) Provided the university hospital executes its accounting based on the Diagnosis Related Groups (DRG), in accordance with 17 b of the Krankenhausfinanzierungsgesetzes / (Hospital Tariff Legislation), it can request an appropriate advance payment for the hospital stay, if, and provided, a sickness insurance cover cannot be proven. (2) Provided the university hospital does not execute its accounting based on the DRG, in accordance with 17 b Krankenhausfinanzierungsgesetz (KHG) / (Hospital Tariff Legislation), it can request an appropriate advance payment for a hospital stay which is predicted to be longer than one week. If an agreement to cover costs has been issued by the responsible authorities, other public or private law sponsors or private health insurance schemes, advance payments can only be requested by these ( 14 par. 4 Bundespflegesatzverordnung (BPflV) / (German Ordinance on Hospitalisation Cost Rate). (3) From the eighth day of a hospital stay, the hospital can request an appropriate partial payment, the amount of which is orientated on the services provided so far in connection with the amount of the predicted fee to be paid ( 8 par. 7 Krankenhausentgeltgesetz (KHEntgG) / (Law on Financing Hospitals). 9

10 13 Leave of absence It is not usually possible to agree a leave of absence with an inpatient hospital treatment. During an inpatient treatment, patients are therefore only authorised to a leave of absence in justified exceptional circumstances and with the doctor s permission. 14 Medical intervention (1) Intervention in the sense of the well being for body and mind of the patient will only be carried out after an explanation regarding the importance and significance of the intervention and the patient s consent. (2) If the patient is unable to express consent, the intervention will be carried out without their consent if this is considered necessary by the responsible hospital physician in order to avoid an impending danger to life or if it is urgently required so as not to significantly impair the health of the patient, unless the patient has expressed wishes to the contrary. (3) Paragraph 2 applies correspondingly, if, in the case of a restrictedly able or unable patient, the legal representative is not available or not available at the right time. (4) Alongside the medical and non-medical personnel, auxiliary medical work may be carried out by those who are studying medicine for the purpose of study and research, but always under the supervision of the physician. 15 Post-mortem examination (1) The autopsy (post-mortem examination) can be conducted if it is necessary in order to establish the causes of death or if it is of scientific interest. In doing so, samples of tissue and internal organs may be removed from the body for the purposes of a separate examination. The post-mortem examination must comply with the medical standard and will be limited to the extent required in order to achieve the necessary results and out of respect for the deceased. (2) A post-mortem examination will not be conducted if the deceased has expressly renounced this beforehand. (3) If the deceased has not expressly agreed to a post-mortem examination, it may be conducted only after the expiry of eight day hours (day hours are the hours from 7:00 to 20:00). If the deceased s next of kin or legal representative counter this decision within the specified period, the post-mortem 10

11 examination will not take place; an objection that is submitted after this deadline must also be taken into consideration, provided the post-mortem examination has not already commenced. Next of kin rank in order of the spouse or registered life partner, grown-up children, parents, grown-up brothers or sister or grandparents. A next of kin could also be a person of full age who has an obvious close attachment with the deceased; they rank alongside the next of kin. In the case of several, equal-ranking relatives, it suffices for just one of these to object. (4) Paragraphs 1 and 3 do not apply in the case of a post-mortem examination which has been arranged by the responsible authorities with a legal authorisation. 16 Recording of data (1) Patient s records, especially medical records, test results, x-rays and other recorded information remain the property of the university hospital. (2) Patients are not entitled to the original documents (par. 1). deviating legal provisions remain unaffected. (3) The right of the patient or his representative to inspect the records or, for a fee, request copies, and the duty to disclosure of the treating hospital doctor, remain unaffected by this. (4) The data will be processed and passed on whilst taking into consideration the legal regulations, especially the provisions regarding data protection, medical confidentiality and social security. The university hospital is authorised to hire a debt collection company to pursue remuneration claims and to pass on the data necessary for this. (5) For scientific purposes, the hospital obtains information from the confidential part of the official death certificate. 17 House rules The patient must observe the house rules of the university hospital. This, in its respective version, is a constituent part of these AVB. 18 Internet access 11

12 In many areas of the hospital, in association with an external partner, the university hospital of Würzburg offers its patients the option of Internet access. Refer to the operating instructions regarding Internet use for more details regarding availability. The General Terms and Conditions of the external partner can be found at the telephone card machines which are located on the hospital site. The Internet access must not be improperly used. No criminally-relevant content may be called up or published and no rights of third parties (like industrial property rights) may be breached. 19 Patient belongings (1) Only the necessary clothing and commodities may be brought into the university hospital. (2) The relatives should take any money and valuables home with them. If this is not possible, the hospital may safe-keep items in a manner that is reasonable for the university hospital. (3) In the case of patients who are incapable of action, money and valuables will be taken in the presence of a witness and taken charge of. (4) Items left behind will become the property of the university hospital if they are not collected within 12 weeks after request. (5) In the case of par. 4, it will be expressly indicated in the request that if the items are not collected they will become the property of the university hospital after the deadline has expired. (6) Par. 4 does not apply to items of property or money and valuables which are being kept by the university hospital. The safe-keeping, surrender and reuse of these items will be carried out whilst complying with the legal provisions. 20 Liability restriction (1) The university hospital is not liable for damages which are caused by: a) persons who are not employed by the university hospital, b) private doctors, including consultants and their vicarious agents when providing the additional service private treatment. In this regard, the contracting party for the medical services is exclusively the doctor who is entitled / authorised to invoice health insurance in his own name. In this case, the university hospital is merely the contracting party for the accommodation, board and nursing care. The university hospital is therefore not liable for any errors made by the private doctor (neither contractually nor in tort). The private doctor is exclusively responsible for errors arising from his medical services rendered. This also applies to errors made by assistants (e.g. subordinate or 12

13 advising doctors) who the doctor involves to aid in the medical services for which he is personally liable. The contractual documentation of the respective specialist hospital will state whether a private physician is working there. (2) In the case of loss or damage to property brought in to the hospital and which remain in the care of the patient, for money and valuables which are not given to the hospital for safe-keeping, as well as for patient vehicles which are parked on the hospital premises or car park, the hospital will be held liable only in the case of wilful intent and gross negligence. The same applies to mail which the employees of the hospital receive. (3) Any claims for damages due to the loss or damage of money or valuables which have been held in safe-keeping by the university hospital as well as for items of property which were in the safe-keeping of the administration, must be asserted in writing within three months after establishing the loss or damage - the period begins with the discharge of the patient at the earliest. 21 Place of payment The payer must pay his debt at his own risk and his own cost in Würzburg. 22 Coming into force These AVB came into force on 1st June Simultaneously, the AVB from 1 st September 1999 and the associated amendments have been lifted. 13