According to the guidelines of the KBV, every service bill and data transmission to the KV must be carried out using certified software. Attorney Dr. Alex Janzen together in the following post.
After § 295 paragraph 4 sentence 1 SGB V Contract doctors must transmit their service invoices to the Association of Statutory Health Insurance Physicians (KV) by means of electronic data transmission, whereby the telematics infrastructure can be used for such transmission. According to Section 295, Paragraph 1, Sentence 1 of the Social Code Book V, another transmission variant is the transmission of the data to the KV on data carriers that can be processed automatically. The detailed procedure for electronic billing to the KV regulates the National Association of Statutory Health Insurance Physicians (KBV) in accordance with § 295 Paragraph 1 Sentence 2 SGB V, which issued revised guidelines for the IT-supported billing of contract doctor services to the KV in 2005 and has updated them several times since then has.
KBV guidelines for electronic billing of panel doctor services
According to the guidelines of the KBV, every service bill and data transmission to the KV must be carried out using certified software. Each software and each certified software module that is certified for the purposes of service billing and data transmission is provided with its own test number in order to enable the software to be assigned correctly. According to the KBV guidelines, each relevant software must be re-certified every three years. The certified software must be such that its quarterly maintenance is ensured. If such maintenance is not possible, the software in question loses its certification.
Before each service is billed, a panel doctor must ensure that they are using a certified software version. In particular, it must be a current version of the corresponding software. If the software in question was not updated or did not run successfully, the software used is no longer certified software according to the explicit provision of the KBV, so that in such a case the billing of services and data transmission are no longer carried out correctly. Before the performance data is sent to the KV, the KBV also stipulates that it be checked by a KBV checking program. Here, too, care must be taken to ensure that an updated version of the examination program is used.
The KBV can subject certified software to an extraordinary control test or a new certification outside of the regular 3-year certification. In which cases this can happen is controversial. At the very least, a control test or re-certification can and should be carried out if there is reasonable suspicion that software does not guarantee proper billing of services to the KV. In addition, the KBV will have discretion as to the cases in which control tests or new certifications of software are carried out.
Certified software must also be used to transfer data from health insurance cards
The certified software can also be used to transfer data from patients’ health insurance cards and electronic health cards. In its guidelines, the KBV only allows three methods for taking over the relevant data: by means of an approved stationary or mobile reading device and by taking over the data from another software that the KVB uses for the Invoice has been certified. When using reading devices for the purpose of data transfer, the KBV prohibits the use of adapter cards, with the help of which the data could be transferred from other hardware and software solutions.
The KBV prescribes special precautions in its guidelines for data transfer by mobile reading devices. After the data has been read by a certified reading device, it may only be transferred to software that has been certified by the KBV for billing. Here, too, care must be taken to ensure that both the software of the mobile reading device and that of the billing program are up to date. The reader software must be set up in such a way that the data transferred is automatically deleted after it has been successfully transferred to the certified billing program.
It is not immediately clear whether the data in question may also be deleted with a time delay, despite the actually clear requirement of the KBV. The KBV prohibits the quarterly saving of the read data on a mobile reading device. This specification of the KBV stands in a certain contradiction to the obligatory automatic deletion of the data in mobile reading devices after the successful transfer to the certified billing program. Because if the data cannot be stored across quarters, they remain stored on the mobile reading device for a certain period of time and are therefore not automatically deleted immediately after being transferred to the certified billing program. The KBV may mean a case when the data is read out and transmitted shortly before the end of a quarter and there is therefore a risk that the storage will be maintained across quarters.
Electrostatic discharge problems when reading eGK with NFC
When using new eGK with the NFC function (Near Field Communication) problems due to electrostatic discharges when reading some electronic health cards have been reported for some time, so that the reader and in some cases even the practice connection to the telematics infrastructure is paralysed. The question could be raised here as to whether contract doctors are obliged to take suitable precautions, e.g. B. by grounding the reader, so that an eGK does not discharge electrostatically in the reader and does not paralyze it.
A general obligation for such precautions, which contract doctors would have to take at their own expense, should be rejected in our view given the current status of the problem. Another question would be whether a separate billing element would have to be created to compensate for the protection of readers in practices against electrostatic discharges. The creation of such a billing fact would have to be supplemented by a uniform technical procedure for the appropriate security of the readers.
Specifications of the BMV doctors for the billing of panel doctors
The Federal Shell Contract Doctors (BMV Doctors) contains certain specifications for the billing of contract doctor services, which supplement the provisions of § 295 Para. 4 SGB V and the guidelines of the KBV.
Section 42, paragraph 1, sentence 1 of the BMV-Ärzte stipulates that blank form forms may only be generated in a doctor’s practice using software certified by the KBV. According to § 42 paragraph 1 sentence 3 BMV-Ärzte, only forms that are linked to the certified version of the software may be used. In the event of problems with the printing of blank forms, the KV will point out the proper use of the forms. According to Section 44 (3) BMV doctors, no stickers, stamps or the like may be attached to invoice receipts with diagnoses or service items from the EBM.
According to Section 44, Paragraph 5 of the BMV doctors, invoices can only be reimbursed if all the necessary data within the scope of Section 303, Paragraph 3 of the Social Code Book V has been transmitted in machine-readable form or has been provided on machine-usable data carriers. The catalog of the data of § 303 Abs. 3 SGB V is extensive, it contains information according to
- § 291a paragraph 2 number 1 to 10 SGB V: certain data of insured persons that is stored on their eGK, in particular the responsible health insurance company, personal information and the health insurance number of the insured person,
- Section 295 (1) and (2) SGB V: data recorded by the billing contract doctor on billed services, in particular the type of use and treatment, the day and, if applicable, the time of treatment, billed fee items and treatment costs,
- § 300 Para. 1 SGB V: certain information from pharmacies and other providers of medicines,
- § 301 paragraph 1 and 4 SGB V: certain information from the licensed hospitals or their hospital operators as well as from preventive care or rehabilitation facilities with a supply contract according to §§ 111, 111c SGB V,
- § 301a SGB V: certain information from self-employed midwives and facilities managed by midwives,
- § 302 Para. 1 SGB V: certain information from other service providers in the field of remedies and aids as well as digital health applications.
If, as part of the contract doctor’s billing, costs are claimed for materials that are neither included in the billable services nor compensated for via consultation hours, the originals of the documents supporting the billing must be regularly attached to the billing. According to Section 44, Paragraph 6, Clause 7 of the BMV-Ärzte, this billing is to be based on the prices actually realized minus any reimbursements and profit-sharing equivalent to reimbursements. According to § 44 paragraph 6 sentence 7 BMV doctors a. E. Only cash discounts of up to 3%.
dr legal Alex Janzen is a lawyer and specialist lawyer for tax law as well as for banking and capital market law in Düsseldorf. He advises companies on tax law, capital market law and medical law, in particular on questions of tax optimisation, taxation of doctors and joint practices, representation in opposition and lawsuit proceedings, on questions of practice financing and on medical and dental fee law.
