Obtaining Short Term Reimbursement
The NUB process allows to obtain short term reimbursement for innovative diagnostic or treatment methods in case the standard hospital DRG reimbursement is insufficient. Individual hospitals can inquire to InEK (Institute for the reimbursement system in hospitals) and request additional reimbursement for the method. In case of a positive decision (Status 1) hospitals can negotiate the required reimbursement with the relevant federal health insurance group. NUB inquiries need to be renewed yearly.
According to §137h SGB V implemented in 2017 new methods involving high risk medical devices and a new theoretical-scientific concept need to undergo an early benefit assessment by the G-BA, which can result in either full reimbursement or exclusion from reimbursement or into a Level I clinical study with full reimbursement of the method and payment of study overhead by the manufacturer.
§137h SGB V
This process is initiated by the first NUB inquiry for a new method meeting the criteria of §137h. For that reason, the applicability of §137h and the resulting chances and risks need to be carefully evaluated.
Kalms Consulting provide strategic recommendations on the NUB process and the associated chances and risks, including consultation of the G-BA. Furthermore, Kalms Consulting support all operational tasks of the NUB process as preparation of the NUB draft, strategic selection of hospitals, communication to hospitals and supporting their negotiation in case of favorable outcomes.