The structure of the textbook is based on teaching in learning fields, in accordance with the specifications of the framework curriculum for the training occupation for medical assistants. With the help of various learning situations, it describes the importance of the learning content for everyday practice.
The book is characterized by a clear structure: After the learning situation at the beginning of a learning field, the most important learning content is clearly explained. In addition, the most important excerpts from the two fee schedules EBM and GOÄ are briefly compiled. What has been learned is illustrated using case studies. Each sub-chapter is followed by questions for practicing and deepening. At the end of each chapter there are “questions and cases”, which enable optimal preparation for the written and practical exams. The pages of this book can be easily removed and put together in a folder according to personal ideas.
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The result is an individual training book.
The new one-volume edition follows the previous two-part edition. It adapts to the times of digitization. EBM and GOÄ are user-friendly on the Internet and available as an APP. Comments and exclusions of an accounting number can also be read there and no longer have to be listed in full in the book. Due to the reductions, both volumes could be merged.
It is important to learn how to deal with the fee regulations. The focus here is on the billing of the family doctor. The specialists are presented as an example based on the invoice from the orthopedist.
Fee regulations: this is how medical remuneration works
The medical remuneration provides that a resident doctor receives a fixed amount of money for each service provided to a patient with statutory health insurance. The fee is based on the uniform assessment standard (EBM) and the budgeted total morbidity-related remuneration (MGV). Outpatient medical treatment is not settled directly with the health insurance company (KK), but with the Association of Statutory Health Insurance Physicians (KV). The negotiation of the reimbursement claims of the doctors takes place between the KV and the health insurance company. This principle also applies to other medically relevant service providers (pharmacies, hospitals, etc.).
The settlement is usually made up of several individual service fees. Each individual performance has a fixed number of points so that proportionality is established. The score of each honorary point is multiplied by an annually renegotiated point value. In total, this results in the doctor’s fee. There are also other forms of remuneration, each of which has different incentive and control effects:
Case flat rate: Billing according to the number of cases treated in a period
Flat rate per capita: Billing according to the number of insured persons to be cared for in a period of time and “registered” with the doctor
Salary: Period-fixed fee
Unlike a person with statutory health insurance, the private patient has a direct contractual relationship with the doctor. The medical remuneration for outpatient services is based on the cost reimbursement principle. The invoice amount transferred by the patient to the doctor can then be reimbursed via private health insurance. When billing the fee, the doctor must follow the fee schedule for doctors (GOÄ). The reimbursement principle in private health insurance between the service provider (doctor), insured service recipient (patient)
