Data exchange according to § 302 SGB V
The data exchange according to § 302 of the fifth book of the Social Security Code (SGB V) aims at the electronic billing with the health insurance companies . It affects all so-called other service providers in the German healthcare system. As early as 1992, within the framework of the Health Structure Act, the legislature obliged the health insurance companies to only reimburse services if the corresponding billing is made on "machine-readable or machine-usable data carriers". The regulations that can be found in Sections 302 and 303 of SGB V apply to all other service providers. In detail, the service providers of therapeutic products, aids and non-medical dialysis services are obliged to invoice electronically. The areas of home nursing , domestic help, providers of ambulance services as well as midwives and obstetricians are also affected .
Consequences of non-compliance
Service providers who do not adhere to the requirements of the health insurance companies and continue to invoice in paper form must expect reductions in the invoice amount of up to 5 percent if they are responsible for not participating in the data carrier exchange process. In such a case, the health insurance companies have to enter the data and can invoice the service provider for the associated costs. Section 302 also provides for this measure. In the 1990s, with the third stage of the health reform, electronic billing found its way into the health care system and was intended to ensure more transparency. The idea behind it: With this type of billing, the service providers provide the health insurers with extensive figures, through which the insurers can discuss with the legislature on a more objective level and also increase competition on the insurer's side.
Come into effect
Section 302 did not come into force at the same time for the individual groups of other service providers. While some professional groups already have to settle electronically with some health insurance companies, other service providers still have a closed period until the procedure becomes mandatory. The reason for this lies in the rather complex development and implementation of such a billing process with a large number of "other service providers", which is associated with extensive technical and organizational tasks for the health insurance companies. The health insurers therefore carry out a test phase during which the accounting data can be transmitted to the health insurances on machine data carriers ( diskette etc.) or via the Internet. In parallel to the machine data, the paper bills are sent to the responsible health insurance companies using the previous billing procedure. There is no reduction in benefits in this phase. When exactly the health insurance companies will end this trial phase, they will inform the other service providers in each individual case. From this point on, the parallel transmission of paper invoices in addition to machine data carriers is no longer necessary. Various health insurances have been implementing the procedure for some time, such as the AOK Sachsen, AOK Hessen or AOK Niedersachsen.
Collectable data
With the electronic billing according to § 302 a whole series of data must be recorded. These can be found in the original documents such as prescriptions or dialysis certificates. In the new billing procedure, billing is made up of the respective billing data for each billing case, the overall statement of the billing (invoice), the prescription sheets, authorization or repair certificates and, if applicable, the benefit promises of the health insurance companies. DTA item numbers, doctor numbers, approval date and approval numbers as well as the group key of the service provider will also be included in the billing in the future. From February 1, 2008, a permanent establishment number must also be specified. This is a doctor's information that is added to the doctor's number and identifies the practice. The most important prerequisite for participation in the electronic billing process is that other service providers have an institution code (IK). You can only be identified as a service provider if you specify the institution code in the statement.
Billing variants
Service providers who have to bill electronically have several options for sending their billing to the cash registers. Billing is possible via a data center that has specialized in this process. In this case, service providers send the paper bill to the billing center, which does the rest. Such an approach is associated with costs, which, however, remain well below the threatened reductions in benefits from the health insurance company. In the meantime, however, self-billing is also possible via the Internet. The service providers themselves enter the data into a screen mask and then send it to the cash register via the Internet. This procedure is also associated with costs, but by entering it yourself it is significantly cheaper than a billing center. Self-billing is also possible with software. This is offered by some manufacturers. The costs for software, updates and usage vary from provider to provider.