🇩🇪Germany

Verpasste Erstattungen bei Eligibility-Fehlern

2 verified sources

Definition

Tests require prior insurance approval; failures result in non-reimbursed services especially for new methods.

Key Findings

  • Financial Impact: 2-5% revenue loss from denied GKV reimbursements
  • Frequency: Per non-pre-approved test case
  • Root Cause: Lack of automated pre-verification with insurers

Why This Matters

This pain point represents a significant opportunity for B2B solutions targeting Medical and Diagnostic Laboratories.

Affected Stakeholders

Vertriebsmitarbeiter, Rechnungsstellung

Deep Analysis (Premium)

Financial Impact

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Current Workarounds

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Methodology & Sources

Data collected via OSINT from regulatory filings, industry audits, and verified case studies.

Evidence Sources:

Related Business Risks

Kapazitätsverlust durch manuelle Prüfungen

Idle time equivalent to 10-20% capacity loss per shift

Bußgelder bei Qualitätsmängeln in der Verifikation

€30,000 fine per ArbStättV violation; up to 10-year prison under MPDG

Verzögerte Abrechnung durch Versicherungsprüfung

20-40 hours/month per lab on manual verification; 2-5% revenue leakage from delayed billing

IVDR-Verstöße in Diagnostiklabors

€30,000 fine (ArbStättV §9); full laboratory closure

Verzögerte Abrechnung durch ePA-Integration

30-60 Tage verlängerte Forderungslaufzeit; 2-5% revenue leakage

EBM-Abrechnungs-Kürzungen und Ablehnungen

Up to 70% cut per reimbursement item; industry turnover €5.5B exposed to mass reductions

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