Differences in the billing of private patients and legally insured persons
In Germany, legally insured patients generally do not receive medical bills from their doctors. Doctors bill the services provided directly to the patients' health insurance.
Only if services are provided which could not be covered by health insurance, will separate invoices be sent to legally insured patients.
For private patients, on the other hand, billing is made directly by the doctor or practice after the invoice has been sent.
What is the structure of a private medical bill?
The fee schedule for doctors (GOÄ) determinesHow medical services can be billed. This applies not only to the way in which invoice amounts are calculated, but also to the structure and content of the medical bill. By the way, dentists bill according to the GOZ (fee schedule for dentists).
In order to make the invoice comprehensible, certain elements must be included. These are explained below.
By the way: There are no fixed names for the individual elements. Headlines in invoices can be called, for example, “GOAE no./GOZ no.” or “fee item.”
Guidelines: These items must be included in the medical bill
- Date of service provision: It is necessary to indicate the date when the benefit was received by the patient.
- GOAE number/GOZ number/digit: Each medical service is stored in the GOÄ with a number, also known as a fee item. The number must be listed together with the corresponding service description. If a number is marked “A”, “a” or as “analog”, it means that it is not included in the GOÄ. In this case, the doctor uses a comparable service for calculation.
- Service description: In addition to the GOAE number, the service provided is described, such as “advice” or “investigation.” If there is a minimum duration for the service, this must also be specified.
- Factor/ rate of increase: The GOÄ provides that there is not just a basic price for a service (single rate). Depending on the difficulty and time required, the single rate can be increased. The medical bill shows the rate of increase for each individual benefit, usually under the term “factor.”
- Amount: The contribution must be listed for each service.
- Costs and expenses: Not only medical services can be charged on the bill. For example, if you have received a pre-financed medication from the practice, this can be billed as an outlay. Travel fees may apply when visiting the house. These and similar expenses must be shown separately on the invoice.
- Quantity (optional): It is stated how often the services were provided on the specified day. However, this information is not mandatory.
Medical bill statute of limitations: What doctors & patients should know
The statute of limitations on a medical bill means that the doctor has the right to demand payment for a certain period of time after invoicing. In Germany, according to §195 BGB, this period is 3 years. This means that the doctor can claim payment within 3 years of the invoice being issued. Once this period has elapsed, the doctor can no longer legally demand payment. However, there are exceptions when special circumstances stop or prevent the statute of limitations.
Important to note here: After treatment or diagnosis alone, no payment is due for the patient. Payment is only due after the doctor has issued the invoice (§ 12 of the GOÄ).
Also to note: The limitation period only begins at the end of the year in which the doctor provided and invoiced the service. Here is a quick example:
Let's say a patient's treatment took place in March 2023. The doctor sent the bill to the patient a month later in April. The 3-year limitation period only starts at the end of 2023. It would be time-barred on January 1, 2027.
In this context, Nelly can factoring be very convenient for doctors. Problems with running behind patients' bill payments and statutes of limitations are a thing of the past because Nelly takes care of the entire process. Get free and non-binding advice on our digital factoring offer!
When does a service expire if no invoice has been issued?
If no invoice has been submitted for the service provided, no limitation period begins, as no claim has been made. The limitation period only starts from the time when the invoice is actually issued.
Protection against forfeiture: In what period of time do doctors have to send their patients the bill?
There is no law that states until when doctors must submit their medical bills to their patients. It sometimes happens that some patients claim the invoice after a few months if it has not been sent before. Our recommendation is that doctors should react quickly to counteract a possible forfeiture of their demands.
When can forfeiture occur?
If, despite the patient's request, a reasonable amount of time passes without billing, the doctor's claims for payment may expire, i.e. forfeit.
Here is the legal justification: If a doctor does not bill on time, this may result in the patient assuming that they have received the service free of charge or that the doctor has waived payment. In such cases, patients and their health insurance companies may argue that the doctor's claim to pay the bill has been forfeited and can no longer be claimed.
To prevent this, a common recommendation is: Doctors should issue their bills on a quarterly basis.
Digital medical bills for greater safety & efficiency
In the age of digitalization, digital medical bills offer an efficient and secure way to process billing between doctors and patients. Here is a short example of what this can look like in everyday practice:
Ms. Müller is treated in a medical practice. The doctor enters the services provided into the digital billing system, which automatically calculates the corresponding fees in accordance with the GOÄ and generates an invoice. This is then sent electronically to Ms. Müller. She receives a notification via email or SMS and can view the bill directly in a portal and pay with a click.
Ms. Müller opens the invoice on her computer and checks the listed services and costs. However, she can also view the benefits & invoices directly as a document in the browser-based patient portal. Everything seems to be correct, so she chooses the option to pay online with her preferred payment method and settles the invoice with just a few clicks. The practice immediately receives notification of receipt of payment.
Ms. Müller immediately receives an automatic receipt by email, which confirms that her payment has been successfully received. All data is securely stored in the electronic patient record so that it can be accessed at any time.
With Nelly, you can complete the process of digital invoicing Easy to implement in your medical practice. Nelly can be easily integrated into your practice management system. If you wish, the process can also be combined with Nelly Factoring.
Benefits of digital invoices for doctors:
- efficiency: Faster processing of payments and less administrative work.
- Accuracy: Electronic recording and storage of billing data reduces errors.
- Safety: Invoice cannot be lost by post. There are also no problems with incorrect deliveries if the patient's address has changed.
- Flexibility: Easy adjustment and update of statements when changes are made.
- automation: Possibility to automatically generate invoices in accordance with GOÄ guidelines. Also: Simply send patients a simple reminder of their due payment via the doctoral portal via the doctor portal
Benefits of digital invoices for patients:
- Convenience: Easier process for receiving and managing invoices.
- Time savings: No physical handling of paper documents required and no typing out IBAN numbers for the transfer.
- Traceability: Electronic access to old invoices and payment information
synopsis
Let's briefly summarize the most important points once again:
A full medical bill must include various elements such as the date of service provision, specific GOAE numbers for the services provided, service descriptions, factors/rates of increase, amounts and any costs and expenses.
In Germany, the is Statute of limitations for medical bills 3 years from the end of the year in which the service was provided and invoiced. Statutory claims from doctors can no longer be claimed in most cases.
The forfeiture of medical bills (= the doctor loses the right to receive payment of his bill) occurs when the doctor does not respond adequately to requests for an invoice, which may result in the loss of the right to payment from the patient.
Digital medical bills offer doctors a good opportunity to increase the efficiency, security and processing of payments. Patients can also benefit from this, as they can view invoices conveniently and transparently, without the physical handling of paper documents or the time-consuming process of typing in IBAN numbers for the transfer. We advise It is free of charge and without obligation.
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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