Filenews 21 July 2021
A particularly warm response was found by the beneficiaries of the GHS, the branch of Physiotherapists, which joined the second phase of its application, with the System now allowing for the carrying out of a number of treatments (depending on the diagnosis) that the Agency compensates.
HOW THE EXPENDITURE IS DONE AND WHAT APPLYS WITH THERAPIES
The beneficiary of the GHSY who may need physiotherapy services has the opportunity to contact his personal physician who will assess whether he needs to receive physiotherapy services or further evaluation from a Special Physician. All Personal Physicians and most specialties of Special Practitioners have the possibility of referring beneficiaries for physiotherapy services.
The beneficiaries, if they obtain a complaint, choose the physiotherapist they want to visit from the list of physiotherapists participating in the GHS and arrange an appointment.
It is noted that the GHS covers a specific maximum number of physiotherapy sessions per diagnosis, per beneficiary, per year. The beneficiary may receive information on the maximum number of visits covered by the System from the attending physician, who will refer him to physiotherapist services, if appropriate. For each physiotherapy session the beneficiary pays a supplement of ten euros.
Two types of referrals are currently issued in the short and medium term. A short-term refer is issued for 3 treatments and has a time limit of 6 months to be performed. A medium-term refer is issued for 6 treatments, and also has a time limit of 6 months to be performed. The number of treatments reimbursed by the GHS, depending on the diagnosis of the beneficiary, is shown in the tables of the covered diagnoses posted on the website of the GHS. Each complaint issued is valid for a single diagnosis.
THE NUMBER OF THERAPIES PER YEAR AND THE EXEMPTIONS
Adult patients are entitled to receive a maximum of 12 treatments per year for diagnoses covering these services. For example, if a reference is issued concerning a diagnosis for which the GHS compensates up to 6 sessions and within the year a new reference is issued concerning a diagnosis for which the GHS compensates up to 9 sessions, if the beneficiary has already received the 6, then only 3 can be executed within the same year.
In cases where the physiotherapist and the attending physician consider that a particular case requires more treatments, they may apply for an exemption jointly, which will be evaluated by the Agency. This procedure shall apply only in exceptional cases of serious health problems and shall provide for detailed documentation of the incident by applicants using a specific form.
The maximum number of treatments that a beneficiary may receive under the GHS shall be calculated on the basis of a calendar year.
EXPENDITURE: THE EXPENDITURE CASES
In cases where a patient provides a reference whose diagnosis (code) is not on the list of diagnoses for which the GHS compensates physiotherapy services, then the services offered will be charged outside the GHS, according to the invoice of the respective provider.
In addition, in cases where the beneficiary does not hold or provide a reference in force, those services shall be deemed to be outside the GSY framework. In this case the physiotherapist has the possibility to perform the visit at the appropriate charge, after first informing the beneficiary. The same shall apply in cases where the beneficiary has exhausted the maximum number of visits as defined by the Agency.
The provision of home care services is not included in the package of services agreed with the Agency. However, if the beneficiary's situation is such that he needs home care, it is up to the physiotherapist concerned if he wishes to provide such services. In any case, one of the existing services included in the physiotherapy services package should be used.
Finally, the physiotherapy services provided during the hospitalisation of a beneficiary in a hospital are compensated in the context of the whole hospitalisation of the beneficiary and do not require any additional compensation on the part of the beneficiary.
