ST Reha tariff

With regard to the reimbursement of individual cases, as in the other inpatient tariffs, the coded ICD diagnoses and CHOP procedures (treatments) play a central role. By including codes of the CHOP procedure classification, the ST Reha tariff structure receives a direct performance reference.

As with the other inpatient tariffs, cases are assigned to the individual flat rates per case by means of a decision tree. In a first step, a case is assigned to one of the ten so-called basic RCGs. The first eight basic RCGs are primarily oriented towards the different types of rehabilitation, as they are also mapped in the CHOP catalogue in the code group BA “Basic service in rehabilitation”. The ninth basic RCG TR80 “Rehabilitation without further indication” contains cases that do not meet the minimum requirements of any of the above rehabilitation types. In order not to set any false incentives, it was determined that the daily cost weight of this ninth basic RCG always corresponds to the lowest of the remaining daily cost weights. RCG TR96 “Not groupable” catches cases with errors. It has no cost weight.

The first eight basic RCGs are divided into up to three RCGs (Rehabilitation Cost Groups) by means of various criteria, such as certain diagnoses or treatments (e.g. additional expenditure in rehabilitation), which are assessed with different daily cost weights. Similar to the TARPSY system, individual RCGs are divided into different phases. In ST Rehab, however, the daily cost weight remains constant throughout an entire phase.

Multiplying the daily cost weights by the length of stay (number of days) of a patient and the base case price finally results in the amount of the reimbursement in CHF. In addition to the flat rates, individual very expensive services (medications, certain procedures such as dialysis, etc.) can be billed and reimbursed by means of additional charges, as is also the case with SwissDRG or TARPSY.

Both the logic of the decision tree of the ST Reha tariff structure and the list of additional charges are regularly revised by SwissDRG AG. This is done in a data-based manner on the basis of the actual service and cost data of the rehabilitation clinics. With the help of the ST Reha application procedure, influence can be exerted on this further development. For example, potentially under-reimbursed services or case groups can be reported or certain modifications can be suggested. eonum offers various services related to the TARPSY application procedure. You can find out more about them on the following offers page: