Guideline on reporting of PHC in the DRG system

The CKS team issues Guidance on the reporting of PHC in the DRG system. The document is being issued as guidance on the 274e data interface and applies to situations occurring from 1.1.2025. The document describes the basic features of the reporting and calculation of case lump sums in the situation where the PHC has, but also does not have, a contracted PHC in the DRG. From both perspectives it looks at and describes approaches such as:

to follow the reporting procedure at sites 1 or 4,

what data interfaces to use,

calculate the case lump sum for inclusion in the NHS and non-NHS DRG groups,

use the List of medical procedures and deductible items for different situations.

This document is intended to help smooth the implementation of the JHS in DRGs. If you have suggestions or questions on how to ensure a smoother implementation of the JHH in DRGs, please feel free to send us your suggestions in the Feedback section of the newly created Overnight Health Care category.