The Belgian National Institute for Health and Disability Insurance (INAMI/RIZIV) provided an update on the structural reform of the Nomenclature, initiated in 2019. This reform aims to overhaul the coded list of medical services reimbursed by compulsory health insurance, specifically focusing on physicians’ services. The current Nomenclature, which links codes to medical professions and specialties, is being restructured to follow an anatomical classification. Additionally, the six-digit codes will be replaced with seven-digit codes, eliminating references to specific professions. INAMI/RIZIV has outlined the progress made and future steps in the reform process.
The reform is divided into three phases: Phase 1, “Restructuring and adapting the description of services,” has been completed. Phase 2, “Establishment of relative value scales for the professional section,” is currently underway. Phase 3, “Development of fees,” is the final phase, which will commence after Phase 2 is complete. The final phase will distinguish between professional fees (covering all costs related to medical service provision) and intellectual fees (covering the doctor’s services). This distinction aims to create a more logical and structured Nomenclature.
Updates on Nomenclature Reform
This update is part of the broader Market Access Monitor service, which provides weekly updates on reimbursement and HTA news from over 80 organizations globally. Subscriptions include access to an online database and email alerts. Contact us for a free, three-month trial. INAMI/RIZIV Nomenclature (and Pseudo-nomenclature) is a coded list of medical services wholly or partially reimbursed by compulsory health insurance. The reform aims to restore a new logic and structure to the current Nomenclature. Only the part of the Nomenclature concerning physicians’ services will be reformed.
Articles for the services of other health professions (e.g., nurses) are not considered in this reform. The following changes are expected: The current Nomenclature is linked to the medical profession/specialty. In the updated Nomenclature, a new classification will apply, which will be based on the anatomical principle rather than medical specialty; The current Nomenclature codes composed of six digits will be replaced by seven-digit codes without any notion or reference to a profession.
Three Phases of Belgian Nomenclature Reform Explained in Detail
Phase 1, which focuses on “Restructuring and adapting the description of services,” has already been completed successfully. This initial phase involved a comprehensive review and update of how services are described, aiming to make them more accurate and reflective of modern medical practices.
Phase 2, known as the “Establishment of relative value scales for the professional section,” is currently in progress. This phase is crucial as it involves setting up a new system to determine the relative value of various medical services. These value scales are intended to create a more equitable and transparent framework for reimbursing medical professionals, ensuring that the compensation reflects the true value and complexity of the services provided.
The final phase, Phase 3, is titled “Development of fees” and will commence once Phase 2 is completed. This phase will focus on developing a new fee structure that differentiates between the professional and intellectual components of physician fees. The professional part of the fees is designed to cover all costs directly or indirectly related to the provision of medical services that are not covered by other sources.
This includes expenses such as equipment, support staff, and facility costs. On the other hand, the intellectual part of the fees is intended to cover the doctor’s services, particularly the expertise and time they contribute to patient care. This distinction aims to create a more logical and fair reimbursement system that accurately reflects the various components of healthcare service provision.
Resource: Mtrconsult, July 01, 2024
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