MD assessment (formerly MDK): questions, preparation, tips & tricks

The abbreviation MD stands for the Medical Service. This is responsible for assessing people with statutory health insurance who have applied for a care degree. The Medical Service assesses the extent of the need for care and prepares an expert opinion for the statutory health insurance companies.

To provide you with comprehensive information about the assessments, the procedure and important preparation tips, we have compiled the most frequently asked questions at the Medical Service and the key aspects of the MDK assessment.

What is the Medical Service?

The abbreviation MD stands for the Medical Service, which is an advisory and assessment service of the statutory health and long-term care insurance funds. On behalf of these insurance companies, the Medical Service examines the need for care of insured persons according to defined criteria. Medicproof, on the other hand, performs these tasks for privately insured persons.

The aim of the Medical Service is to support people in need of care and their relatives and to ensure that they receive all the benefits to which they are entitled.

MD instead of MDK

Since 2019, the Medical Service of the Health Insurance Fund (MDK) has been known as the "Medical Service" (MD). This name change was prompted by the MDK Reform Act, which came into force in 2019. This law declared the Medical Service to be an independent body under public law. As a result, the Medical Service now acts neutrally and is no longer bound to the potential interests of the health insurance company.

Tasks of the Medical Service

The medical service is responsible for four areas:

1. Assessments for health insurance companies: This includes, for example, determining whether home nursing care is required or whether an incapacity to work still exists.
2. Advice on medical care issues: The MD offers advice on topics such as decubitus prophylaxis or nutrition for dementia.
3. Assessments for long-term care insurance: This includes the recommendation of a care degree following a long-term care assessment in the event of a need for long-term care.
4. Ensuring the quality of care: The MD offers home care consultations that are required in order to receive care allowance.

The responsibilities of the MD are defined in Section 275 of the fifth German Social Security Code (SGB V) precisely defined.

Who are the experts from the medical service?

The Medical Service (MD) assessors include experienced care professionals, doctors or people with other relevant qualifications. They are employed directly by the MD and not by your care insurance fund.

The MD has acted as an independent body under public law since 2019 and acts neutrally, without being influenced by the interests of long-term care insurance and health insurance companies. This is to ensure that you are assessed fairly and receive all support options and services that are appropriate to your individual situation.

MDK assessment procedure - the care assessment

The Medical Service (MD) plays a central role in determining a care degree for people in need of care. Nevertheless, it is the long-term care insurance fund that first commissions the MD with the assessment and ultimately decides on the care degree. Here are seven steps that illustrate the path to a care degree:

1. You submit an informal application for a care level or an upgrade with the responsible long-term care insurance fund.
2. Your statutory long-term care insurance fund will appoint an MD assessor who will make an appointment with you for the assessment. assessment with you. This assessment usually takes place at your home, but can sometimes also be carried out by telephone or video call.
3. During the assessment, the assessor will assess your situation and ask specific questions based on set assessment criteria. These criteria are binding for all long-term care insurance companies, regardless of your insurance.
4. After the appointment, the assessor will draw up a care assessment in which they evaluate your independence and care needs, recommend a care level and determine whether aids are required.
5. The MD will forward the care assessment to your care insurance fund, which will send you the care decision.
6. The long-term care insurance fund makes a decision on the care degree on the basis of the report, whereby it can deviate from the recommendation of the MD assessor.
7. You will receive written notification of the care insurance fund's decision no later than five weeks after submitting your application. If you do not agree with the decision because no care level or a care level that is too low has been determined, you can lodge an appeal.

Tips for preparing for the MD assessment

The Medical Service (MD) assessor usually schedules around one hour for their visit to the person in need of care. This time is often limited in order to gain a comprehensive insight into the entire day-to-day care routine.

Here are some tips on how you can best prepare for this.

Keeping a care diary

In order to optimally prepare for the assessment by the Medical Service, it is advisable to keep a care diary. In the days leading up to the appointment, you can record the amount of care you need. This not only helps the assessor to get a comprehensive picture of your situation, but also makes you more aware of your care needs. It is important to be honest and not to gloss over anything, but also not to exaggerate. The aim is to obtain the necessary care services that are appropriate to your situation.

Forward-looking scheduling

Careful planning of the appointment can be a great advantage. If the family member requiring care is in a better mood in the morning than in the afternoon, then the caregiver should schedule the appointment for the assessment by the Medical Service for the afternoon. In this way, the assessor can experience the care situation and the areas of life that are most challenging for you. If the person in need of care requires assistance with eating and drinking, it is advisable to ensure that this situation also takes place during the appointment.

Natural living atmosphere

Be prepared for the assessor to visit all rooms that are relevant to your care, including your bedroom and bathroom. If necessary, the assessor will also make recommendations for aids in the report for the care insurance fund that could make everyday care easier for you in the future. However, you should not tidy up excessively, as this will only appear unnatural and will not give a realistic picture of your everyday care routine.

What questions does the MD ask during the assessment?

The MD asks questions and assesses 6 relevant criteria during his visit.

1. Mobility: In this step, the assessor tries to determine whether the person is still able to move to another location. In the context of care, this may mean that the person is able to change their position in bed, sit upright or stand up. It is also checked or asked whether the person is able to climb stairs independently.
2. cognitive and communicative abilities: As part of the care degree assessment, the assessor attempts to determine whether the person concerned is still able to orient themselves in terms of location and time. It is also examined whether the person concerned is able to manage the household independently and make independent decisions in daily life. All of these questions are asked by the assessor in order to evaluate the need for care and determine the level of care.
3. Behavior and mental health problems: This section of the assessment examines how the insured person behaves in relation to other people. Particular attention is paid to determining whether there are signs of conspicuous or aggressive behavior and whether delusions are present.
4. Self-careThearea of self-care has the greatest influence (40%) on the award of a care level. Here it is examined whether the person concerned is able to independently manage their own basic needs such as personal hygiene, dressing and undressing as well as the preparation and intake of food. Possible incontinence in this area is also examined.
5. Coping with and independently dealing with illness- and therapy-related demands and stressesInthis section of the assessment, the Medical Review Board (MDK) assessor wants to find out whether the person concerned is able to take medication independently and/or whether they are able to attend medical appointments independently.
6. Organization of daily life and social contactsInthis part of the assessment, the focus is on checking whether the person in need of care has adequate rest and sleep times, whether they are able to carry out their activities and plans properly, and whether interaction with other people works.

The MD assessor awards points based on various situations and areas of life within a criterion. The scale ranges from 0 to 3, where 0 stands for no restrictions and 3 for a high level of restriction.

The scoring system

In order to better understand the points awarded by the MD, we have provided the respective points with meanings and examples.

• 0 points means either "present" or "unimpaired", and for time measurements it means "never". For example, if no assistance is required for doctor's appointments or therapy sessions, the need for assistance for this particular activity is indicated as "never". In addition, temporal or spatial orientation can be assessed as "present" or "unimpaired".
• 1 point stands for "mostly present / unimpaired" or, in the temporal context, "rarely". If you can mostly climb stairs on your own but are only occasionally impaired, for example if your osteoarthritis temporarily worsens, the assessor can award one point for climbing stairs and assistance.
• 2 points means "slightly present / impaired" or "frequently". For example, this could mean that you can eat small snacks independently, but need help with all other meals. In this case, independent eating is impaired.
• 3 points mean "not available / impaired" or "always". In these cases, you generally need help with an activity, such as giving insulin injections, going to the toilet or similar.

Possible aggravating factors for care

Every person is unique, and so is every care situation. This is also reflected in the assessment guidelines of the Medical Service (MD), which take into account so-called aggravating factors. These factors make the care of the person in need of care more difficult in everyday life than it may appear at first glance during the assessment. These aggravating factors include, for example

• Body weight of >80 kilograms
• Severe pain that cannot be alleviated by therapy
• a severe impairment of sensory perception (e.g. hearing or vision)
• Restrictive spatial conditions
• Swallowing disorders
• Respiratory disorders
• Defensive behavior
• severe spasticity

What comes after the care degree assessment?

Once the assessor has completed the home visit, the report is forwarded to the long-term care insurance fund to determine the care level. The long-term care insurance fund will make a decision about your care level shortly after receiving the report in order to provide you with planning security. You will then receive written notification of the allocation of your care level and a copy of the assessment report.

Good preparation for the Medical Service (MD) and the MDK assessment is crucial in order to present your individual needs appropriately. Knowing the typical questions asked by the MD and preparing for the appointment will maximize your chances of receiving the support you deserve. There are many resources and medical service tips available to help you prepare for your MDK assessment.

If your application is rejected, which is not unusual, you can lodge an appeal within one month. Even if you do not agree with the decision or the expert opinion, for example because the classification seems too low, an informal appeal is possible. In this case, however, you will be asked to provide a reason for the appeal.

The MD audit and guidelines for quality in care

The Medical Service not only has the task of assessing people insured under the statutory long-term care insurance scheme, but is also responsible for monitoring the quality of care. Politicians are therefore striving for a regular and reliable assessment of care homes and care services in order to answer the question "How good are our care facilities?".

For this reason, the 2009 Long-Term Care Further Development Act decided to inform those in need of care and their relatives about the quality of every care facility in Germany. To this end, special catalogs of criteria were developed, which the experts used to evaluate every care facility in Germany. These evaluation systems made it possible to regularly assign grades to each care facility for the quality of care provided.

MD grades for the evaluation of nursing homes and care services

Since fall 2009, care ratings for care facilities and outpatient care services have been published nationwide on the Internet. Similar to school grades from 1 (very good) to 6 (unsatisfactory), they are intended to give consumers a quick overview of the quality of these facilities.

The assessment procedure is quite straightforward: Assessors carry out a quality inspection of all German care facilities and care services once a year.

The basis for this quality assessment is formed by the so-called Quality Review Guidelines (QPR). These guidelines are continuously updated and improved. There are two different guidelines: one for the inpatient sector and one for the outpatient sector. Both serve as the basis for the quality assessment of a care company.

Quality assurance in the inpatient area is carried out by checking 59 individual criteria in four main areas:

1. Nursing and medical care
2. Dealing with residents with dementia
3. Social care and everyday activities
4. Housing, catering, housekeeping and hygiene

In the outpatient area, 37 individual criteria are checked in three main areas:

1. Nursing services
2. Medically prescribed nursing services
3. Service and organization

The evaluation is carried out in three steps:

1. Review of the individual criteria
2. Calculation of an average for each quality area
3. Determination of the overall grade

The care company's overall score is then published in a uniform and clear layout that is easy to read.

For a detailed insight into the rating of a particular care facility with a score of 1, an on-site transparency report can be requested. This report provides a detailed breakdown of the rating. However, the care grading system also presents certain challenges: As an overall score is formed, shortcomings in individual areas can be partially concealed or offset by other good scores.