Spots the OPS codes where the Hybrid DRG must take precedence before a case is billed as inpatient.
Developed in Germany · Hosted in the EU or on-premises
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Advisory and implementation for the public sector, starting with the AI readiness assessment.
The case is coded after discharge; the procedures are recorded as OPS codes in the hospital information system. Whether it becomes an inpatient DRG or a Hybrid DRG depends on individual codes from a list of hundreds. The wrong route usually only comes to light when the health insurance fund sends the case back, and by then the revenue has long been booked.
There is no return from billing and no rebooking, because the route is settled at the six procedure codes, and revenue leakage falls by 50%.
The 50% reduction in revenue leakage is this agent's headline figure. Six codes per case and the return via the insurer's review trace a typical case in hospital billing; none of it was counted.
The agent reads the assigned OPS codes from the hospital information system and checks them against the current Hybrid DRG catalogue. Every match is shown with code and reference.
Case 2026-114872, 6 procedure codes checked, 1 match in the Hybrid DRG catalogueThe agent shows which route takes precedence for this case and which detail tips the balance. If the detail contradicts the documentation, it flags the case.
Routed to Hybrid DRG, deciding code OPS 5-530.31, operation report page 2, paragraph 3The agent writes codes, matches and references into a review note on the case. Medical controlling sets the final coding.
vermerk_fall-2026-114872.pdf, 6 check points, 1 flagged contradictionFor case 2026-114872 it checks the six procedure codes against the Hybrid DRG catalogue and names the match. Medical controlling assigns the coding and is responsible for it.
It marks the route that takes precedence in the review note. The hospital billing specialist triggers the release of the case to the insurer.
Whether the procedure required an inpatient stay is documented in the operation report and is a matter of clinical judgement. It points to the passage, nothing more.
Connected systems
Operations
A pilot typically runs on your own data within 4 to 6 weeks. The agent connects to your existing systems rather than running as a separate, parallel environment.
EU cloud, private cloud or on-premises. Processing is GDPR-compliant and models are never trained on your data. Details in the Trust Center.
It is based on experience from comparable projects and process benchmarks, not a commitment. We work out the realistic effect for your organisation during the assessment before the pilot.