Dr. Wilke GmbH. Inspiring Health

DRG-Management

Professional DRG-Management: Some case Studies

Case Study 1

Our customer had established a claims management system mainly relying on non-medical staff. Specific requests by the the MDK were forwarded to the hospital physicians, who were not always familiar with complex claims and cost issues. As a result, the hospital received less money than it would have been entitled to. The hospital management decided to establish an efficient medical claims controlling system.

What We Did

Dr. Wilke GmbH started by working on the backlog of files of the previous months. Then we developed a new concept with the customer. The customer learned from a cost-benefit analysis that outsourcing would be the best option for them. We began building up a new department structure (which involved liaising with the senior consultants and other medical staff) and set up processes to integrate, inform and train all stakeholders. With our support the hospital was put into a position to settle claims again.

Case Study 2

The medical controller of a hospital resigned. Finding a new qualified employee was difficult and would take about nine months. As there were no processes in place to deal with MDK requests, there was a substantial number of unanswered questions and expert opinions. In the meantime health payers had begun to set deadlines and reduce invoice amounts and nobody in the hospital was able to deal with that in an appropriate manner.

What We Did

Until a new medical controller was found, we handled all expert opinions and questions with regard to claims, we analyzed the results and communicated them to the physicians and other stakeholders thus ensuring the hospital’s liquidity.