1. Sondergebühren in Deutschland -- Teil 3.
- Author
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Stoffels, Markus and König, Maximilian
- Subjects
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HEALTH care industry billing , *GOVERNMENT policy , *MEDICAL laws , *LABOR contracts , *MEDICAL care , *CONTRACTING out , *PHYSICIANS , *HOSPITAL utilization - Abstract
The article "Special Fees in Germany - Part 3" deals with the remuneration and billing of medical and non-medical elective services according to German law. It explains the point system of the official fee schedules that is used to calculate the amount of remuneration. In addition, the framework conditions of the liquidation rights of chief physicians are presented. The article deals with various aspects of the fee schedule for doctors (GOÄ) and dentists (GOZ). It is pointed out that the billing of services always depends on the individual case. In order to enable a better allocation of non-coded cases, the medical associations issue analog lists. The fee demand must be reasonable and must not be disproportionate to the services provided. There is a mandatory flat-rate reduction of 25% for certain private medical services. Deviating agreements on the amount of fees are possible, but must not be contrary to public policy. The remuneration becomes due when an invoice meets the legal requirements. The article deals with the liquidation rights of doctors in Germany. The liquidation right refers to the right of doctors to demand separate remuneration for personally provided services and to bill them directly to the patient. It is discussed whether the liquidation right has an influence on hospital remuneration. The question is also raised whether subordinate doctors should be involved in the revenues generated by elective services. The inclusion of non-medical personnel in these regulations is inconsistent. In some federal states, hospital operators and/or chief physicians are legally obliged to involve senior and assistant doctors in the revenues from the liquidation right. The revenues generated are collected in a pool and paid out according to qualification and participation. Doctors are also professionally obliged to involve subordinate doctors in the revenues from billable services. In case of disputes over the entitlement to remuneration, a lawsuit can be filed before the ordinary courts. The place of jurisdiction is determined by the place of performance of the hospital admission contract. The elective service can be provided either as an employment contract service or as an independent activity, which entails tax differences. The classification of the activity as independent or dependent also has an impact on social security contributions and insurance coverage. The assessment of whether the elective service is provided independently or dependently is based on the overall picture of the circumstances and the contractual arrangements. The text deals with the distinction between independent and dependent service provision in hospitals. An essential characteristic is the formal and actual separation between the services of the hospital and the doctor. A uniform appearance of the hospital and a uniform obligation to pay by the patient speak for dependent service provision, while individual assignability and sole access to the revenues by the chief physician are strong indications of independence. Other criteria are ownership of entrepreneurial initiative and the distribution of economic risk. The integration into the business organization of the hospital and the use of the hospital's infrastructure and personnel are also relevant factors. The distinction between independent and dependent activity is made based on the circumstances in each individual case. [Extracted from the article]
- Published
- 2023
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