BLS proposal for equalizable calculation of pay for prophylactic examination depending on the percentage of the covered
To
Prof. Dr. Petko Salchev
NHIF
Concerning: Implementation of Art. 174c, para. 2-7 of the R&D for Medical Activities 2020-2022
Dear Prof. Salchev,
In connection with the application of Art. 174c, para. 2-7 of the R&D for medical activities 2020-2022, and in particular with the equalization calculation of the payment for a prevention examination, depending on the percentage of health insured persons over 18 years of age, we offer you the following:
- For the months of activity: July, August, September and October 2022, the pay/the ongoing pay should be calculated on the basis of the percentage covered by persons in proportion to the respective month, such as: for each GP, the average proportional issue of ZOL over 18, Subject to cover with a prophylactic examination for the respective month is calculated by the formula:
Average monthly proportional number of ZOL over 18 years of age, subject to cover with a prophylactic examination for month x = (number approved for pay persons in line GP01 18- 65Y + number approved for payment persons in line GP01 65-200Y from the list of the OPL for the months of an activity from January 2022 to m. x (m. 7. 8, 9, 10)) /divided by H. for each GP, the percentage of the ZOL prophylactic examination over 18 is defined as the month for the month The number of reported and approved for the month of preventive examinations of the ZOL over 18 is divided into the average proportional number of ZOL over 18 years of age, subject to coverage with a prophylactic examination for this month. And then:
- If the percentage of coverage per month X is less than or equal to 46%, then all preventive examinations for the month should be paid at a price of 20 BGN or, accordingly, to calculate the equalization value = no. Views * 20 BGN - pc. Reviews *25 BGN
\ - If the incidence per month is 46.01% to 60%, - the price for each preventive examination for the month is 25 BGN.
- Prior to payment of the activity for the month of November 2022, due in December 2022, an annual equalization will be carried out on the basis of the reported and approved no. Activities in a row of GP05 "Annual Prophylactic Reviews of ZOL over 18 years" for the period January 2022 - November 2022.
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