Digitalization has revolutionized almost every area of life in recent years. In Germany, however, developments in some sectors, especially when compared with other countries, are still lagging behind. In healthcare in particular, digital progress is often hampered by bureaucratic regulations that make efficient digital transformation difficult.
Here is a brief illustration: The written form for fillings in the dental sector in accordance with Section 28 (2) SGB V was established 27 years ago under the government of Helmut Kohl. Back then, 3% of the German population had Internet access via their modem; smartphones were out of the question. The Merkel government therefore introduced the electronic form for fillings in the orthodontic sector in 2019 with Section 29 (7) SGB V. However, this was not regulated uniformly for all treatments and specialties.
Documents with written form requirement
Some dental practices are therefore uncertain which documents still need to be signed in “written form”, i.e. manually, in accordance with the current state of legislation, and which can be safely signed digitally with Nelly. In view of the fact that this responsibility and documentation requirements fall within the area of responsibility of the dentist, some practices are concerned about a loss of fees or want legal certainty.
The present guidance is therefore intended to clarify which documents are clearly subject to a written form requirement at this point in time according to the legal text:
Billing, Section 10 Paragraph 6 GOZ
The first signature of new patients for patient consent to submit data for billing purposes. (EWE - Declaration of Consent for Invoicers)
Honorary Agreement, Section 2 Paragraph 1.2 GOZ
This fee agreement is used when the factor of 3.5 is exceeded. This means that if the fee amount differs, the fee agreement must be drawn up and signed in writing by the patient before the start of treatment.
This must be considered in particular when agreeing on fees in accordance with Section 2 (1) and (2) of the GOZ:
- Conclusion of the agreement before the start of treatment
- written form
- no lump sum agreement
- Note, the refunder may not refund everything
- Handing over an imprint to the patient
Payment services, Section 2 (3) GOZ
Requested services are all treatments that are not medically necessary. As with the fee agreement, a treatment and cost plan (ICP) must be drawn up before the start of treatment and signed in writing. In particular, this ICP must include the benefit with the corresponding remuneration and a reference to demand performance, including a reference to any non-reimbursement.
Examples of demand services:
- Filling replacement because tooth color doesn't like it (but filling is intact)
- New crown because it doesn't like the shape (crown edges are sufficient though)
- Cosmetic tooth reshaping (e.g. closing a gap in the front teeth)
- Second prosthesis/travel prosthesis
- whitening
- tartar
Additional cost agreement MKV filling, Section 28 Paragraph 2 SGB V
With filling therapy, the patient can choose between filling the health insurance and filling with an additional payment. The written form is only required in cases where the patient opts for filling outside the health insurance provider. Because here, the patient bears the additional costs himself and must therefore sign this additional cost agreement before the start of treatment.
Fewer bureaucratic hurdles in healthcare soon
The good news: In the future, it is likely that more and more documents will be effectively digitally signed in Germany's dental practices. The Federal Government recently adopted key points on the Fourth Bureaucracy Relief Act (BEG IV). It aims to make the electronic form or the text form in the Civil Code (BGB) the legal form and to use the written form only as a substitute for the electronic form.
In concrete terms, this means that electronic written form should become the future standard in legal transactions. Numerous written form requirements are abolished. In addition, with the Act to speed up the digitization of healthcare (Digital Act — DigiG) and the Health Data Use Act (GDNG) the further framework for a modern and digitally supported healthcare system will be created.
Please note that this guide was created for informational purposes only, has no legally binding effect and does not involve any legal advice. In addition, this guidance was only prepared with regard to formal civil law requirements. We have compiled this document on the basis of extensive research and legal opinions. The ultimate responsibility for signing documents remains the personal responsibility of doctors.
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