How to make a permanent recipe
Long-term need for medicinal products and special prescription needs
Patients with serious illnesses often need a permanent supply of medicines. Depending on the diagnosis, this can be physiotherapy, occupational therapy or speech therapy. In the case of prescriptions with long-term therapeutic needs or special prescription needs, the therapist should pay attention to a few points and also be aware of the differences.
What is a Long Term Remedy Need?
There is a long-term need for remedies if there is a need for therapy for at least one year. The ICD-10 codes, diagnoses and the corresponding indication codes can be found in the Therapeutic Products Directive, Appendix 2. The standard case does not have to be run through, i.e. the prescription is directly outside the standard. There is no requirement for approval by the health insurers for the diagnoses listed. The amount prescribed must match the frequency and patients must have a medical check-up at least every 12 weeks. It is also positive for therapists that these prescriptions do not burden the doctor's budget.
What is a special prescription requirement?
Due to the severity of their illness, patients with a special need for prescriptions (previously: specialty practices) require medicinal products to a particularly intensive extent, usually for a limited period of time. This can be the case, for example, after a cerebral infarction or after postoperative care. These regulations are therefore only recognized by the health insurers for a certain period of time. Here, the normal case must be followed and approval for regulations outside the normal case must be obtained from some health insurers. For some diagnoses, a second ICD-10 code is required to mark the prescription accordingly. These prescriptions do not burden the doctor's budget either.
What are the main differences that the therapist needs to know?
In the case of long-term therapeutic needs, the normal case does not have to be followed and there is no requirement for approval.
If there is a special need for a prescription, the normal case must be run through and approved by some health insurers. You may have to check the additional ICD-10 code here.
Is there a maximum number of interruptions allowed per prescription for long-term remedy needs?
The same requirements apply here as for normal ordinances. The rules depend on the respective framework agreements with the payers. The basic rules and requirements for AOK and replacement funds can be found in our online overview - as well as links to the framework agreements.
Does the 12-week period apply to prescriptions outside the normal range from the date of issue or from the start of treatment?
Unfortunately, there is no uniform regulation here either. The specifications from the framework agreements apply, which are different. If in doubt, you are on the safe side with the date of issue.
What about similar diagnoses that are not listed under Long Term Remedy Needs?
Here the patient must submit an individual application to their health insurance company. For approval, it is crucial that there is permanent damage comparable to the diagnoses listed.
Can a permit be applied for retrospectively if there is a special need for a regulation?
Approval must be applied for before the start of treatment. Subsequent submission is not permitted.
If there is a special need for a prescription, can the therapy also be started before the health insurance company has approved the treatment?
You can treat the patient up to the justified objection by the health insurance fund. All treatments performed up to that point will also be paid for. Most health insurance companies accept the application for approval by fax.
Diagnostic list with ICD-10 codes
Diagnostic list of long-term therapeutic needs and special prescription needs
Overview of the approval procedures outside of the normal case
Interruption periods and framework agreements from AOK and substitute funds
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