1. Sprechstundenbedarf: Lieferung durch pharmazeutischen Großhändler.
- Subjects
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HEALTH insurance companies , *MEDICAL offices , *CONTRAST media , *MEDICAL prescriptions , *OFFICE equipment & supplies - Abstract
The article deals with the delivery of contrast agents as office supplies by a pharmaceutical wholesaler. The wholesaler is entitled to compensation for the delivered contrast agents, which were delivered directly to contract doctor's practices. Framework agreements with other suppliers do not exclude the wholesaler's entitlement to compensation. The Federal Social Court has ruled that the wholesaler is entitled to compensation. The supplier's invoice must be submitted with the medical prescription and the costs must be itemized. The examination of cost-effectiveness is carried out by the Joint Examination Facility. It is determined that wholesalers have a direct entitlement to compensation from health insurance companies when they deliver contrast agents directly to contract doctor's practices. The office supply agreements in Rhineland-Palatinate and Saarland contain corresponding provisions. The Federal Social Court has ruled that pharmaceutical wholesalers are to be considered as other service providers within the meaning of § 69 (1) sentence 1 SGB V. The delivery of contrast agents to contract doctor's practices as office supplies by wholesalers is part of medical care and is subject to the billing regulations of health insurance companies. The interpretation of the office supply agreements does not establish a separate entitlement to compensation for wholesalers from health insurance companies. The framework agreements concluded by the health insurance company with other suppliers do not exclude the wholesaler's entitlement to compensation. The article also deals with the suspensive effect of an objection against a recovery notice in connection with target value regressions for contract doctors. An objection has a suspensive effect and the Association of Statutory Health Insurance Physicians can issue a recovery notice to recover regression amounts. The regulation in § 52 (2) sentence 2 BMV-Ä is not applicable in this case. The recovery notice has a suspensive effect according to § 86a (1) sentence 1 SGG. [Extracted from the article]
- Published
- 2024
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