The Medical Service, MD for short (formerly MDK), is an organization that is responsible, among other things, for the assessment of people applying for a application for a care degree and are covered by statutory insurance. The MD then assesses the degree of need for care and prepares an expert opinion for the statutory health insurance companies. Find out more about the Medical Service and its tasks here, as well as tips for the assessment appointment and how to prepare for it.
What is the Medical Service of the Health Insurance Funds (MDK)?
The MDK, the Medical Service of the Health Insurance Fund, is a service that provides independent medical advice and assessment and evaluates patients objectively according to predefined criteria. Since the MDK Reform Act [mfn]MDK Reform Act[/mfn] came into force, the medical service has assessed patients independently of the health insurance funds. The MDK uses a checklist to ensure that all people in need of care receive care insurance benefits under the same conditions. In accordance with the Social Security Act, the MDK acts professionally independently and assessors act exclusively according to their medical and nursing conscience.
The MDK's report is decisive for classification into a care degree. The main purpose of the MDK is to determine the extent to which a person is in need of care and assistance in order to enable access to long-term care insurance benefits.
In the event of a care case in your family, you or a relative must first submit an application for a care degree to the care insurance fund without specifying a specific care degree. The MDK will then contact you to arrange an assessment appointment and determine the level of care.
If you or your relative already have a recognized care level but believe that it is not sufficient, you can apply for an adjustment of the care level.
MDK - Tasks at a glance
The MD (formerly MDK) comprises various areas of responsibility, such as:
- Ensuring the quality of care
- Care assessment
- Patient protection
- Checking hospital invoices
- Review of new treatment methods
- Advice and assessment
Ensuring the quality of care
The employees of the medical service check the quality of the various care services once a year and publish the results.
Care assessment
Every year, care experts or doctors from the MDK visit over 1.4 million people who have applied for care services. In personal discussions, they determine how much support the person in question needs, which also includes the calculation of the level of care. The results of these examinations are recorded in an expert report, which serves as the basis for the benefits provided by the long-term care insurance fund.
Patient protection
The health insurance funds are available to provide support if there is a suspicion of a treatment or care error. The MDK carries out an investigation by means of a specialist report to determine whether an error has occurred and whether any damage has been caused as a result. This expert opinion is free of charge for those insured with statutory health insurance.
Checking hospital invoices
The MDK carries out assessments for health insurance companies. Every year, around 20 million people are treated in German hospitals. The bill for the treatment is sent to the health insurance company. However, the billing procedure between hospitals and health insurance companies is complex. It can therefore happen that an invoice contains errors. If a health insurance company has doubts about an invoice, it is checked by the MDK.
Review of new treatment methods
Although new examination and treatment methods can bring progress, they are not automatically better than tried and tested procedures. This also applies to new medicines such as cancer drugs. For this reason, the MDK examines on behalf of the health insurance fund whether the use of a new method would make sense. In doing so, the MDK is guided by evidence-based medicine, which is based on scientifically tested methods that have been proven to be effective.
Advice and assessment
As an advisory and assessment service, the MDK helps health insurance companies to ensure that their policyholders receive appropriate care. The MDK doctors are available to answer questions on various topics such as aids (e.g. prosthetic legs or hearing aids), rehabilitation measures or home nursing care. In addition, the MDK is also called in to answer questions about the insured person's inability to work. In some cases, examinations by MDK doctors are necessary.
Who are the medical service experts?
The experts from the Medical Service (MD) are experienced professionals in the field of nursing, medicine or have other relevant qualifications. These experts work for the MD and are not employed by your care insurance fund.
The Medical Service is an independent organization under public law and acts neutrally, independently of any interests of the long-term care insurance company. This guarantees a fair assessment that ensures you receive all the support and benefits you are entitled to according to your individual situation.
5 steps to a care level
Application for a care degree
You have various options for applying for a care degree. This can be done either via an online form, by letter, by telephone or in person at the care support center. If you opt for a written request, you do not have to provide any detailed information before the assessment appointment. A questionnaire for care assessments from the MDK is available for telephone inquiries.
Commissioning of the MDK
After you have applied for care benefits, the long-term care insurance fund commissions the Medical Service (MDK) to carry out an assessment. The MDK then checks whether and to what extent you are in need of care. This ensures that you receive the benefits you need. Privately insured persons are usually contacted by the Medicproof assessment service.
Announcement by the MDK assessor
An assessor will contact you in good time to inform you of the date for the assessment. This will give you enough time to invite a relative or carer to the appointment.
The MDK assessment
The assessor will come to your home to get an idea of your care situation. He or she will check to what extent you are dependent on help and whether you need any aids. It is recommended that you speak openly about your situation so that an objective assessment is possible.
Determining the level of care
Once all the information is available, you will be assigned a care level. This makes it easier to approve future benefits quickly and reliably. The care level can change over time. If you would like an adjustment, you can contact your care insurance fund.
You are free to lodge an appeal if you are dissatisfied with the MDK's classification so that you receive the benefits to which you are entitled.
Preparation of the MDK assessment
Here you will find our MDK checklist with all the necessary documents that you can compile before your care assessment. It is important to ensure that you have all the necessary documents to hand, as this will simplify and, above all, speed up the process:
- Questions you would like to ask the assessor.
- Reports from your attending physician.
- Names and contact details of your attending physicians.
- Discharge reports from the hospital.
- A list of all medications to be taken.
- If available, your disability card.
- If available, the care documentation or the care diary.
- Contact details of the person who was previously responsible for care.
- A list of the tools already in use.
How does the medical service assessment work?
Once the appointment for the care assessment has been made, it is important to check that all the necessary documents are available. You can check this using our checklist above. Before the appointment, you can also think about some questions or discuss them with your relative if it concerns their need for care:
- What challenges do I face in everyday life?
- Where do I need or want support?
- What can I do on my own?
If you are already being cared for by a family member or another person or are caring for someone else, it is advisable to attend this appointment together. This way, you can support each other and objectively assess skills, for example.
If you are taking medication, have your medication schedule ready. It is also advisable to prepare doctor's reports and hospital reports. If you do not have these to hand, you do not need to request them separately. Additional data can help the assessor with the assessment. You can also support the assessment process by completing an MDK questionnaire for the care assessment in advance. The information will form a good basis for the interview.
Finally, if you keep a care diary, have this ready for the assessment appointment.
An employee of the Medical Service (MDK) will be sent to your home by the care insurance fund to determine your care level based on a specific list of criteria. Your abilities and independence are assessed in eight areas of life, also known as modules, with six of these modules being relevant for the assessment. Each of these modules contains specific sub-criteria, which are assessed with point values based on the existing limitations.
Children under the age of 18 months are classified one care level higher, as they have a basic need for care. More on care levels for children.
Evaluation during the MDK assessment
Furthermore, the six modules are included in the overall assessment with different weightings. For modules 2 and 3, the module with the higher score is taken into account.
- Mobility (10%)
- Cognitive and communication skills and
- Behavioral and mental health problems (15%)
- Self-sufficiency (40%)
- Coping and independent handling of illness- or therapy-related requirements (20%)
- Organization of everyday life and social contacts (15%)
What is checked during the assessment by the medical service?
Remember that the MDK visit is not an examination that you have to pass in order to receive care services. You should therefore not put yourself under pressure and feel that you have to present yourself with excessively good performance. It is also not advisable to present your remaining independence and abilities as worse than they actually are. Assessors are trained to recognize when a situation is being presented more dramatically than it is and will recognize this.
The aim of this visit is to determine your actual care needs. To make this possible, it is important to provide all information truthfully. Therefore, be realistic when presenting yourself and do not conceal or trivialize any problems. This is because concealing or playing down problems can lead to you being classified in a lower care level than you are entitled to. As a result, you may not receive the financial and care support you need.
As already mentioned, six areas of life are decisive for the assessment, as they provide information about the independence of the person in need of care. A recognized need for care is certified if the care assessment results in a score of at least 12.5 points in the various areas of life (modules). It is checked whether the person in need of care is still able to cope with everyday life independently or whether help is required.
Mobility
- Can the person assume different postures?
- Does the person concerned have problems moving?
- Does the person in a position experience pain?
Cognitive and communicative skills
- Can the person in need of care recognize people and take part in conversations?
- Does the person recognize dangers and can they assess them?
- How good is the person's spatial and temporal orientation?
Behavioral and psychological problems
- Are there any behavioral problems?
- Does the patient often become restless or are there increased mood swings?
Self-sufficiency
- Can the person in need of care take care of their personal hygiene independently?
- Does the person have difficulty dressing or undressing?
Coping and independent handling of illness- or therapy-related demands and stresses
- How often does the person need help with taking medication?
- Is the person able to care for wounds independently and cope with appointments?
Organizing everyday life and maintaining social contacts
- To what extent can the person manage their everyday life independently?
- Can the person maintain social contacts?
Overview of the MDK assessment in points
- Care level 1: 12.5 to 27 points
- Care level 2: 27 to 42.5 points
- Care level 3: 42.5 to 70 points
- Care level 4: 70 to 90 points
- Care level 5: 90 to 100 points
Points awarded by the medical service
The scoring from 0 to 3 is best understood if it is explained with concrete everyday examples and corresponding words.
0 points mean that the ability or behavior is "present" or "unimpaired", or "never" in the case of temporal measurements. For example: If you do not require assistance with doctor's visits or therapy appointments, "never" need for assistance is assigned for this activity. Similarly, temporal or spatial orientation can be considered "present" or "unimpaired".
1 point means that the ability or behavior is mostly "present/unimpaired", or in the temporal context "rarely". If you can climb stairs alone most of the time, but are only occasionally impaired, for example if your osteoarthritis gets worse for a short time, the assessor can give you a point for climbing stairs and the help you need.
2 points means that the ability or behavior is "slightly present/impaired" or "frequently". For example, this means that you can eat small snacks independently, but need help for all other meals. In this case, your ability to eat independently is impaired.
3 points mean that the ability or behavior is "not present/impaired" or "always". In such cases, you will always need help, for example when giving insulin injections or going to the toilet.
The modules are weighted and the points are added together to determine the recommended care level. The MD assessor forwards the assessment to the care insurance fund.
How is the need for care for children determined?
In contrast to adults, who lose skills and independence in the course of their lives due to illness or disability, children have to develop these skills gradually. Therefore, when assessing children's need for care, their abilities are compared with those of a healthy child of the same age.
Children up to the age of 18 months in need of care have a special situation, as they are generally dependent in all areas of everyday life and would possibly receive no or only a low level of care if this fact were not taken into account. Therefore, the two age-independent areas are taken into account for a more precise assessment of their need for care:
- Behavioral and psychological problems (e.g. supporting the child in dealing with psychological stress) and
- Coping with illness- or therapy-related demands and stresses (e.g. medication provided by parents).
In addition, children up to the age of 18 months are classified one degree of care higher than determined during the assessment.
Aggravating factors in care
The MD assessment guidelines recognize that every care situation is unique and presents certain challenges. These challenges are referred to as aggravating factors and make caregiving more difficult than it may seem at first glance. These factors include:
- A body weight of over 80 kilograms
- Contractures or stiffening of large joints
- Malpositions of the extremities
- Severe spasticity, such as can occur with hemiplegia or paraparesis
- The need for mechanical urinary solutions or digital rectal emptying
- Swallowing disorders, impaired oral motor skills or breathing problems
- Defensive behavior or lack of cooperation, especially in the case of mental disabilities or mental illnesses
- Severely impaired sensory perceptions such as hearing or sight
- Severe, therapy-resistant pain
- Spatial conditions that hinder care
MD grades for the evaluation of nursing services and nursing homes
Care ratings for care companies have been published online throughout Germany since fall 2009. Similar to school grades from 1 (very good) to 6 (unsatisfactory), they are intended to provide consumers with a quick overview of the quality of care homes and outpatient care services.
The procedure is quite simple: once a year, experts carry out a quality inspection in all German care facilities. The quality inspection guidelines (QPR), which are continuously updated and optimized, form the basis for this. There are separate guidelines for the inpatient and outpatient sectors.
The QPR for the inpatient sector comprise 59 individual criteria in four quality areas, while the QPR for the outpatient sector examine 37 individual criteria in three quality areas. The individual criteria cover aspects such as nursing and medical care, dealing with dementia, social care, daily routines as well as living, catering, housekeeping and hygiene.
The grades are assessed in three steps: First, the individual criteria are checked, then an average is calculated for each quality area and finally the overall grade is determined. The overall grade is published in a standardized, clear and easy-to-read format.
A transparency report can be requested on site for a detailed insight behind the rating of a particular facility with a score of 1. Despite their usefulness, the care grading system also has its drawbacks: Since an overall score is formed, deficiencies in individual areas can potentially be offset by good scores in other areas.
