In Germany, billing for medical treatments is often complex and can appear quite confusing to outsiders. Typically, we negotiate your medical case simultaneously with several specialists and hospitals.
Although this process is time-consuming, it ensures the best possible care for the patient and saves money in each individual case — for the patient or their payer. A brief explanation of the different billing systems in the German healthcare system can be found here:
The DRG system (Diagnosis Related Groups), used for billing medical services in German hospitals, includes a wide range of items divided into various categories and subgroups. These items cover not only physician services but also other resources and cost centers necessary for the diagnosis and treatment of a patient. The key components of the DRG system are:
The main reason for the hospital stay as well as other relevant diagnoses.
Surgical interventions and other therapeutic measures performed
Time and resources allocated for the patient’s nursing care.
The number of days the patient spends in the hospital.
Cost Centers such as medications, materials, diagnostics (e.g., laboratory tests, imaging procedures), and therapies (e.g., physiotherapy, occupational therapy).
Within these DRGs, numerous subcategories exist that are used for billing individual services. In addition, there are the so-called EBM (Uniform Value Scale) and GOÄ (Fee Schedule for Physicians), which are applied for detailed billing of individual medical services and each cover hundreds to thousands of specific service items.
For in-depth information on DRG billing, several reliable sources are available:
The InEK is the central body responsible for the development and maintenance of the DRG system in Germany. Their website offers comprehensive information, reports, and the current case-based lump sum catalogs (DRG catalogs).
Website: https://www.g-drg.de
The BMG regularly provides updated information on health policy and hospital billing systems, including regulations and legal frameworks regarding DRG billing.
Website: Bundesministerium
The DKG also offers expert information on DRG billing and its development, regularly publishing statements and explanations regarding changes in the DRG system.
Website: https://www.dkgev.de
The KBV provides specific billing information for physicians, which can also be relevant for the classification of DRG usage.
Website: https://www.kbv.de
