What does a medical controller actually do?
Medical controlling is a young and fast growing profession of great importance. The introduction of the DRG system (Diagnosis Related Groups) in 2003 revolutionized the accounting system for inpatient hospital cases.
Decisive: Severity and Intensity of Treatment
Each hospital case previously billed according to the number of days of stationary treatment, regardless of the type and severity of the illness, has been reimbursed since 2003 based on the severity and intensity of the treatment provided.
Such procedures require complete documentation of the relevant medical history and the course of treatment, as well as a correct and complete »translation« of the diagnoses and procedures into special codes. Based on the codes, a DRG with a defined relative value is determined for each case according to a defined algorithm which, together with the base rate or case value, determines the amount of compensation. Only optimized processes in documentation and coding ensure necessary revenue in relation to the consumption of resources - and thus the economic future of hospitals.
This gave rise to the development of a professional group which was tasked with translating medical content into valid controlling data. In the beginning, these medical controllers were mostly medical doctors, who assumed this task as a »one-man band«. Due to the importance and increasing complexity in the context of the further development of the DRG system, a professionalization of the job profile »Medical Controlling« quickly emerged. The majority of hospitals throughout Germany now have their own medical controlling department.
Medicine, Health Economics and Business Administration
Although documentation and coding is still the basis of the operative business, this occupational group’s technical expertise, consisting of medical, health economic and administrative knowledge, has led to medical controlling assuming further key areas of responsibility within the entire company.
In this respect, tasks such as corporate development involving design of the medical portfolio, or the preparation and analysis of medical and economic codes or key indicators, are as much a part of everyday business as budget negotiations with health insurance providers, tasks in quality management, or improvements to treatment procedures with regard to an economically-optimized length of hospital stay.
Medical Service of the Health Insurance (MDK)
Due to the often complex accounting systematics, a very intricate verification procedure was developed parallel to the DRG system for the purpose of accurate accounting. The health insurance providers, as cost bearers, check hospital invoices, for which they use the Medical Service of the Health Insurance (MDK). This results in audit rates of up to 20 percent and, in some cases, very different views on the part of the various interest groups. Sound legal judgement is as much a feature of a good medical controller as the organization of a professional MDK management.
The development opportunities are just as varied as the tasks of a medical controller. As an employee in a medical controlling department, you can specialize in a specific area, such as key code or figure reporting, MDK management, process and project management, or quality assurance. As head of an entire medical controlling department, you assume responsibility for personnel and act as management staff. Should you find your focus in corporate development, you are often directly assigned to the managing director and are decisively involved in the development of your company.
With the consecutive Master's program in Hospital Management at MSH you can qualify for management and leadership functions in the front line up to and including management of health care facilities.