Regulatory reductions in an unusual perspective

Overview

The case study deals with the result of assessment of reasons for applying for regulatory reductions in a physician specialized in gastroenterology (105) in an outpatient health care facility, who raised objections against their application (including calculation). Assessment in the framework of controls and revisions revealed that the calculation of the regulatory reduc-tion value was influenced by an incorrect reporting of financial costs for the care of a complement using an erroneous code of an applicant in a reference period. Therefore, the significant increase of cost for required care was found in an actual period. The recalculation of regulatory reductions was undertaken after refusing erroneous documents of a contractual health care facility and providing new documents based on the correct code of an applicant. The regulatory reduction was significantly lower than the former one afterwards. Reasons for the increase of financial costs for induced care of the complement in an actual period, which was presented by the health care facility in objections, did not correspond to the findings revealed during mentioned controls and revisions.

Key words:
outpatient specialist – regulation – assessment of reasons