How can I avoid billing errors

GOÄ tips: Tricky questions and frequent billing errors that you as a doctor should know and avoid

According to GOÄ, services are billable when they have been provided in full. But what about services that you as a doctor had to stop for whatever reason or that did not lead to success? Take the attempt at resuscitation, for example. You try to save human life according to all the rules of medical art - but in vain: the attempt fails and the patient dies.

In this case, you will not go empty-handed for your efforts, because the attempt at resuscitation is an independent fee item in the GOÄ (section 429). Some other attempts that do not bring the desired success are also defined in the GOÄ as billable services, such as the "attempt to extract ureteral stones" (item 1815) or the "attempt to bring back a trapped hernia" (item 3282).

The situation is different if the fee figure does not expressly honor the attempt or partial performance. Then you have to differentiate. For example, if an imaging diagnostic procedure does not lead to success because the device is defective or incorrectly set, then you have not performed the service according to the rules of medical art (§ 1 GOÄ) - with the result that it is not billable. If, on the other hand, a patient does not remain still during an X-ray exposure despite being requested to do so and the X-ray exposure becomes unusable as a result, you can bill the service in full according to GOÄ.

Another example: With a magnetic resonance tomography, the patient becomes anxious, so that you as a doctor finally stop the process. Although the patient is not at fault, the service is billable according to GOÄ. For the GOÄ billing, it is advisable to switch to a lower-valued fee item. Alternatively, you can use an analog service if a lower-rated fee item is not available and the service is comparable in terms of type, time and cost.

Which errors are often encountered in the GOÄ billing?

Errors and inadequacies in the GOÄ billing sometimes significantly reduce the practical benefits. The correct delimitation of the treatment case is only one example. There are frequent errors, for example, with services for which certain unknown combinations of digits are possible, which could be increased or which are simply forgotten in the billing. The transmission of the findings to the patient (number 2), for example, is sometimes just a short telephone call that does not appear in the bill. If this error runs through many GOÄ accounts, it is about significant losses.

It is even more serious if the surcharges A, B, C and D for the medical services are lost in the billing. Depending on the surcharge for services provided outside of the office hours in the evening or at night as well as on Saturdays, Sundays and public holidays, up to 18.65 euros are missing per invoice.

In addition, the reimbursement of expenses, surcharges for outpatient operations and the consultations between doctors (item 60) are often overlooked in the GOÄ statement.

The correct GOÄ billing is therefore an essential part of the added value. The optimization potential that results from errors and inadequacies can therefore be clearly noticeable in a practice.

Complete and timely documentation plays a major role in this. Not only is it forgotten as little as possible through prompt noting, it has also been a statutory obligation since 2013 (Section 630 f BGB). The documentation is the cornerstone for complete liquidation and is important for clarifying possible objections to the invoice. The documentation can also be made up for. But experience shows that patients sometimes make very detailed notes on information and treatment. Then it can get embarrassing when a practice has only made additions at random. In addition, courts consider late replenishments to be untrustworthy, especially if they take place after the start of disputes.

In general, an optimized process not only achieves one-off effects, but also increases economic success over the long term. The earlier this is recognized in practice, the greater the effect for the entire professional life.

As a billing service provider, privadis helps you avoid typical billing errors and sustainably increase your practical benefits. In addition to checking your patients' creditworthiness and address, billing according to GOÄ and sending invoices, the scope of services also includes a plausibility and completeness check. You can find out more about the privadis service here.