For many gynaecologists, it is more than annoying: the benefit statement. Instead of focusing on their patients, they spend around seven hours a week on administrative tasks, many of them invoicing. There are a few things to consider — in particular the differences in private and contract medical fee statements.
Note: Here you can find out How orthodontic billing works.
This is how EBM billing works
Contract medical services are provided in accordance with the nationwide uniform evaluation standard (EBM) settled with the Association of Statutory Health Insurance Physicians. There are complex requirements: Doctors may only provide a certain number of EBM services per quarter. How many these are is defined in the standard benefit volume, which health insurance companies determine on a quarterly basis. In total, gynecological treatment cases amounted to over 11 million in the fourth quarter of 2020 alone! The average fee turnover per case was 55.94 euros.
These services are listed in EBM
The EBM includes general practitioner, specialist and jointly billable services and also takes material costs into account. Gynecology services can be found in the eighth section of Part III b:
- 8.2 Basic gynecological packages
- 8.3 Diagnostic and therapeutic fee schedule items
- 8.4 Obstetrics
- 8.5 Reproductive medicine
- 8.6 Cryopreservation of egg or sperm cells or germ cell tissue and appropriate medical measures for germ cell-damaging therapy
You can download the latest version of EBM at Website of the Federal Association of Statutory Health Insurance Physicians call.
How to calculate your fee according to EBM
At EBM, you will find both flat rates and fees for individual services. Each service has a own fee schedule item (GOP) And many also have a Score.
example: The “Apparatus examination of a patient with urinary incontinence” in part 8.3 has GOP 08310 and 605 points.
In order to determine the costs, the points are calculated with the Guideline value multiplies. It is currently 11.2662 cents per point.
Example 1: The costs for the “apparatus examination of a patient with urinary incontinence” amount to: 605 x 0.112662 euros = 68.16 euros.
Example 2: A “proof of pregnancy” with GOP 32132 is remunerated at a lump sum of 1.30 euros.
For services that go beyond contract medical care (IGEL services), there is another billing basis, namely the GOÄ.
This is how billing according to GOÄ works
If you treat private patients and self-payers or if your legally insured patients would like additional or IGEL benefits, calculate according to Schedule of fees for doctors (GOÄ) off.
The GOÄ can be found online here.
More leeway when it comes to fee calculation
With fixed minimum and maximum rates, you are not completely free in your pricing, but you can adjust the costs to suit the respective effort. In the end, higher fees can therefore usually be achieved than with contract medical treatment.
Important: Conclude a treatment contract with your patients before starting treatment. This creates transparency and security for both sides.
How to calculate costs according to GOÄ
As in EBM, the services in the GOÄ are numerals and scores assigned. The nationwide uniform point value It is currently 0.0582873 euros.
example: The “seam of a complete dam crack (3rd degree)” with the GOAE number 1045 has a score of 924. For the simple fee rate, this means the following calculation: 924 x 0.0582873 euros = 53.86 euros.
With GOAE billing, depending on the effort and level of difficulty, you can set a rate of increase Apply from 1.0 to 3.5. A factor of 2.3 is usually selected.
example: The performance “suture of a perfect dam crack (3rd degree)” should be calculated using 2.3 times the rate. This means the following calculation: 924 x 0.0582873 euros x 2.3 = 123.88 euros.
Increase more than 2.3 times? These requirements must be met
You can decide at your discretion which factor is appropriate in each individual case. However, care should be taken when choosing a 3.5 times increase rate. According to Section 5 (2) of the GOÄ, you must meet special requirements for this. For example, the increase requires a written explanation in the invoice with regard to:
- difficulty,
- time spent,
- circumstances
In addition to the special features when choosing the rate of increase, there are also rules for digit combinations to consider.
Beware of GOAE exclusions
The GOÄ states that certain digits may not be billed together. You can find out what these are specifically in the respective service statements, notes or in the general regulations of the GOÄ.
example: The “suture of a complete perineal fracture (3rd degree)” with the number 1045 cannot be settled with benefit 1044 (“suture of the soft birth paths even after previous artificial enlargement and/or suture of a perineal fracture of the first or second degree and/or suture of a vaginal tear”).
Due to regulatory hurdles, billing according to GOÄ proves to be a demanding task that costs gynecologists and their practice staff a lot of time. Many are therefore wondering how they can make the process more efficient.
Invoicing internally or externally? These are your options
You can reduce your GOAE billing effort in two ways. Either by hiring external service providers or using digital technologies.
Hire external billing services
If you decide to outsource your billing to a service provider, there are two different options: real and fake factoring. With both options, you will not receive the invoice amount from the patients, but from your service provider. The difference lies in the risk of payment default.
- Real factoring: In doing so, the billing service assumes the full risk. The invoice amount cannot therefore be reclaimed from you.
- Fake factoring: If an invoice remains unpaid, the billing service can claim back the advance invoice amount from you.
You don't want to “hand over the billing”? Then simplify your internal processes with digital solutions!
Use digital billing helpers
An external factoring company is not a must for gynecologists who want to spend less time settling fees. Digital billing software like Nelly not only saves you and your employees a lot of time, but also money — for example, 30 percent billing fees! Your additional advantage: No further training is required to use Nelly. You can get started right away!
Gynecological GOAE billing made easy with Nelly
Thanks to Nelly's innovative technology, gynecological services are billed automatically for private patients and self-payers. You can enter all necessary data, such as the payment method, directly on your patients' smartphones with just a few clicks. Wir advise you without obligation and free of charge to your individual case!
The personal names used in this article always refer equally to all persons. Dual naming and alternate names are omitted in order to improve readability.
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