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Current events: Billing Covid tests as optional services despite additional fees? § 26 KGH vs. § 17 KHEntgG

Frank Sarangi, LL.M. Lawyer, Specialist lawyer for medical law

11. January 2024

We are currently receiving an increasing number of enquiries from #hospital providers re-garding the #billing of #Covid services as part of #elective service agreements. The topic may seem trivial at first, but on closer inspection it is perhaps somewhat more complex.

According to Section 26 KHG (Act on the Economic Security of Hospitals and the Regulation of Hospital Nursing Rates), costs incurred by #hospitals for testing for infection with the SARS-CoV-2 coronavirus in patients who are admitted to the #hospital for full or partial in-patient #hospital treatment are financed with an additional charge. According to Section 17 (1) KHEntgG (Act on Charges for Full and Partial Inpatient Hospital Services), in addition to the charges for full and partial inpatient #treatment, services other than the general hospi-tal services may be charged separately as #elective services if the general hospital services are not affected by the elective services and the separate charging has been agreed with the hospital.

So far so good and quite simple, one would think, because the two relevant regulations are quite clearly formulated. According to this, elective services may always be agreed in addi-tion to general hospital services, which means that Covid tests carried out as part of the elective services may of course also be billed as part of the elective services.

However, the private health insurance providers are of the opinion that Covid services serve the general #danger defence and therefore cannot be elective services per se.

In the matter itself, there are currently only two decisions by local courts that have come to the clear conclusion that the billing of Covid services within the framework of effective elec-tive service agreements is permissible if the billing requirements of an elective service ag-reement are met. The Federal Ministry of Health came to the same conclusion.

Of course, the decisive factor is always the consideration of the individual case. However, a hasty repayment should not be made without a legal examination of the facts. Please do not hesitate to contact us.