Contract dentist
Dentists (also cash dentist ) is an established dentist with a dental practitioner seating. In Germany, every licensed dentist has a legal right to be granted a contract dentist license , provided that he meets the legal requirements. Admission requires entry in a dentist register , which is kept by the statutory dental associations (KZV), which organize the contract dentistry . It takes place on the decision of an admissions committee and only applies to the district of the health insurance company.
Since around 90% of the population have statutory health insurance, the establishment of a dental practice usually requires participation in contract dental care. After approval, the contract dentist can work independently in his own practice , in a joint practice , a professional community (formerly: joint practice) or in a medical care center (MVZ) and can bill all contract dental services for those with statutory health insurance via the KZV.
Regardless of the contractual relationship is one of the dentists in both Germany to the liberal professions and in Austria to the liberal professions .
Admission requirements
Admission to contract dental care requires entry in the dentist register of the responsible dental association. The entry is usually made in the dentist register of the licensing district in which the dentist is domiciled. With his application for approval, the dentist submits to all provisions of the fifth book of the Social Code (SGB V), the federal cover contract , the general contracts and replacement health insurance contracts at state level and the statutes of the statutory health insurance association to which he belongs.
The entry is only made if
- you have a license to practice medicine and
- At least two years of preparation time have been completed.
The preparation must include at least six months as an assistant or representative of one or more contract dentists, during which he should familiarize himself with the special features of contract dentistry. A job as a representative can only be recognized if the dentist has previously worked for at least one year in an employed position as an assistant to a contract dentist or in university dental clinics, dental stations of a hospital or the public health service or the armed forces or in dental clinics.
No preparation time has to be proven if a diploma from another member state of the European Community or another signatory state of the Agreement on the European Economic Area is presented and an admission to practice is available. This rule applies regardless of the nationality of the dentist.
Professional association
In § 33 Zulassungsverordnung dentists (dentists ZV) lays down the conditions for the formation of a professional association:
“(2) The joint exercise of contract dental work is permitted among all service providers authorized to provide contract dental care at a joint contract dental office (local professional association). It is also permissible in the case of different contract dentist offices of the members of the professional community (supra-local professional community), if the fulfillment of the duty of care of the respective member at his contract dentist's seat is guaranteed to the required extent, taking into account the participation of employed dentists and the member and the dentists employed by him The contract dentist offices of the other members only work for a limited time. Joint professional practice, based on individual services, is permitted, provided that this professional group is not formed to provide referral-related medical-technical services with service providers who are authorized to refer. "
authorization
In special cases, the competent admissions committee can authorize dentists to participate in contract dental care, for example to avert an undersupply. The authorization is to be limited in terms of time, space and scope. In this context, the authorization has the same legal consequences as an authorization.
Employed dentist
The employed dentist does not provide his own contract dental services, but works in an employment relationship. His employer (licensed dentist) is responsible for monitoring his treatment. The employed dentist cannot settle accounts with the KZV himself. His services are billed through the employer. Employment can be a quarter, half, three-quarters or full-time. The employed dentist only becomes a member of the relevant KZV if he is employed at least half a day. All members of a KZV are entitled to vote in the body elections that take place every six years for the representative assembly of the respective KZV.
According § 32b para. 1 Dentists Approval Regulations (dentists ZV) ", the dentists dentists in accordance with § 95 para. 9 SGB V do. In the federal shell contracts, uniform regulations are to be made about the number of employed dentists taking into account the obligation of the employing contract dentist to provide care. "
According to Section 9 Paragraph 3 of the Federal Contract Dentists (BMV-Z) “the contract dentist can employ dentists to work at his contract dentist's office within the framework of the general licensing regulations. In this case, the contract dentist is still obliged to personally manage the practice. The services provided by employed dentists to the insured represent services of the contract dentist, which he has to settle as his own to the KZV. The contract dentist must personally guide and monitor the employed dentists in the provision of services. Under these conditions, three full-time dentists or part-time dentists can be employed at the contract dentist's office in a number that corresponds to the maximum working time of three full-time dentists. If the contract dentist wants to employ four full-time dentists, he has to prove to the admissions committee before the approval is given which precautions are taken to ensure personal practice management. "
Freedom of establishment
The provisions applicable in the area of statutory health care for so-called `` needs approval '', according to which planning areas must be blocked due to existing or threatened under- or oversupply, have been in force since April 1, 2007 with the entry into force of the GKV Competition Strengthening Act (GKV-WSG) for the area of contract dentists Supply has been eliminated. In this respect - in contrast to doctors - there is freedom of establishment for dentists.
Age limit
Both the admission and the authorization or the activity as a salaried dentist ended earlier according to § 95 Abs. 7 u. 9 SGB V when the dentist reaches the age of 68. The law for the further development of organizational structures (GKV-OrgWG) abolished the legal age limit of 68 for contract (dental) doctors on January 1, 2009. A softening of this age limit for contract doctors already took place with the Contract Doctor Law Amendment Act (VÄndG), which came into force on January 1, 2007, for underserved planning areas. With the previously applicable provision in Section 95, Paragraph 7, Clause 3 of SGB V, the approval of a contract doctor usually ended at the end of the quarter in which the contract doctor reached the age of 68.
Contract Doctor Law Amendment Act
The licensing as a contract dentist has also been largely liberalized through the Contract Doctor Law Amendment Act.
Section 19a Zahnärzte-ZV
“(1) The license obliges the dentist to perform the contract dental work full-time.
(2) The dentist is entitled to limit his supply contract to half of the supply contract according to paragraph 1 by means of a written declaration to the admissions committee. "
An activity of less than 10 hours a week is a quarter job, 10 to 20 hours a week as a half-time job, 20 to 30 hours a week as a three-quarters job and more than 30 hours a week as a full-time job.
Section 24 Zahnärzte-ZV describes the possibility of a dentist working in several locations.
“(3) Contract dental activities outside the contract dentist's seat at other locations are permitted if and to the extent that
1. This improves the care of the insured in other places and
2. the proper care of the insured at the place of the contract dentist's seat is not impaired. "
Billing of contractual dental services
The billing of contract dental services (treatments) is based on the assessment standard of dental services . It is the result of negotiations between representatives of the health insurance companies and dentists at the federal level. The current version came into effect on January 1, 2004. In this evaluation standard, each individual performance is rated with points. The point value in euros is negotiated annually, partly at the federal level (dentures) by the National Association of Statutory Health Insurance Dentists , and partly at the state level by the KZV . The fee is calculated by multiplying the number of points by the point value.
Insofar as dental services are provided as benefits in kind for those with statutory health insurance , the health insurance companies pay, as in the case of medical treatment, "in accordance with the overall contracts to the respective KZV with discharging effect, total remuneration for the entire contractual dental care of the members residing in the district of the KZV including the family members who are also insured . ”( Section 85 (1) SGB V in conjunction with Section 72 (1) sentence 2 SGB V).
No additional payment
In principle, those with statutory health insurance are entitled to the services contractually agreed between the health insurance companies and dentists, which - apart from exceptions (see additional cost agreements) - may not be made dependent on an additional payment by the health insurance patient .
Additional cost agreements
In the following cases, co-payments by the legally insured patient are permitted. The prerequisite is the patient's written consent prior to the start of treatment.
Dental fillings
The additional cost agreement for filling therapy is regulated in § 28 SGB V. There it says: “If insured persons choose additional care for dental fillings, they have to bear the additional costs themselves. In these cases, the health insurance companies must invoice the comparable, cheapest plastic filling as a contribution in kind. In the cases of sentence 2, a written agreement must be made between the dentist and the insured person before treatment begins. The additional cost regulation does not apply to cases in which intact plastic fillings are replaced. "
These include B. modern plastic fillings according to the dentin-enamel-adhesive process , gold inlays, ceramic inlays and much more .
dentures
Since the introduction of the fixed subsidy for dentures (until 2004 a percentage fund subsidy was paid), a distinction has been made in the supply of crowns and dentures between standard care , similar and different types of care. Standard care is billed according to the assessment standard for dental services (BEMA). For this, the patient receives a diagnosis-oriented fixed allowance. In the case of similar care, the BEMA as well as the fee schedule for dentists (GOZ) and in the case of different care is only charged according to the GOZ. The patient must bear the difference to the fixed allowance for standard care himself.
Non-contractual services
Non-contractual services are excluded GKV services. These include, on the one hand, legally excluded services, regulated in Section 28, Subsection SGB V such as
- Functional analysis and functional therapy ,
- Orthodontic treatment for insured persons who have reached the age of 18 at the start of treatment,
- Implantological services , unless there are rare exceptional indications for particularly severe cases to be determined by the Federal Joint Committee in guidelines according to Section 92 (1).
On the other hand, this includes services that are excluded by binding guidelines. For example, the patient is only entitled to one tartar removal per year. More frequent tartar removal or professional tooth cleaning (PZR) are to be borne by the patient himself. Likewise, root canal treatments are only contractual services under certain conditions.
budgeting
By budgeting dental services, the total budget of a state KZV must not be exceeded. If there is a risk of exceeding the total remuneration limit, a fee distribution standard applies , which is designed differently depending on the KZV area. It either enforces a reduction in the fee for the individual services (which may lead to recourse , i.e. to repayment) or a decrease in the amount of services provided by the dentists.
reimbursement
All insured in the statutory health insurance (GKV) in Germany since 1 January 2004, the possibility of replacing the benefit in kind principle the reimbursement to choose. Since April 1, 2007, according to Section 13, Paragraph 2, Fifth Book of the Social Code (SGB V), it has been possible to restrict the choice to the area of medical care, dental care, the inpatient area or services provided. In the cost reimbursement principle , the patient is treated as a self-payer ( private patient ) according to the fee schedule for dentists (GOZ) or the fee schedule for doctors (GOÄ), pays his invoice directly to the doctor and has the reimbursable portion reimbursed by his health insurance company . The health insurance company only reimburses the amount that would have been paid if the health insurance scheme for dentists, the assessment standard for dental services (BEMA) had been applied, minus a flat rate of a maximum of 5% for the administrative expenses and lack of an economic audit , i.e. for the waiver of budgeting. Individual health insurance companies, e.g. B. the Techniker Krankenkasse, waive this discount. Most health insurances also accept assignments from patients, so that the dentists can settle accounts directly with the health insurer and the patient saves administrative work.
Billing of those insured with the basic rate
The statutory health insurance associations also have to ensure the care of those insured persons who are insured with a private health insurance company in the so-called basic tariff . These insured persons are entitled to treatment (and a corresponding reimbursement of costs) comparable to that of the statutory insured persons. These comparable services are calculated according to the private fee schedule for dentists (GOZ) with a limited multiplier (2.0 times the rate). The 2.0-fold rate of the GOZ was set as part of the 2007 health reform called the GKV Competition Strengthening Act as fee-appropriate to the health insurance tariff, the assessment standard for dental services (BEMA).
Billing of non-contractual dental services
Numerous treatments are not part of the contract dental care. These services are billed privately according to the fee schedule for dentists (GOZ) or according to the fee schedule for doctors (GOÄ). The costs are to be paid by the patient (or person liable to pay), who in turn can take out private supplementary health insurance . Services that do not belong to the catalog of services of the statutory health insurance companies are called non-contractual services . These must - after the patient has been informed about his entitlement to benefits in kind and the additional costs incurred - be agreed in writing with the patient before the start of treatment.
These include in particular:
- all services that violate the economic efficiency requirement in accordance with Section 12, Paragraph 1 of Book V of the Social Code , i.e. that exceed the criteria of the contribution in kind, namely “sufficient, appropriate, economical, necessary” . The wording of Section 12 (1) SGB V is as follows:
“The services must be sufficient, appropriate and economical; they must not exceed what is necessary. Services that are not necessary cannot be claimed by the insured, service providers are not allowed to provide and the health insurances are not allowed to approve. "
- Professional tooth cleaning (PZR)
- Functional analysis and functional therapy services
- Dental implants (apart from exceptional indications)
- Orthodontic services for people over the age of 18 (apart from exceptional indications)
Compulsory training
Regular participation in advanced training events is necessary to maintain the contract dentist license (regulated by Section 95d SGB V), otherwise there is a risk of a reduction in fees or withdrawal of the license.
According to the legal regulation, a contracted (dental) doctor has to provide proof to the statutory health insurance (dental) medical association every five years that he has complied with his training obligation in the past five years; the period is interrupted for the period of suspension of admission. If the previous approval ends as a result of the contracted (dental) doctor's departure from the district of his contracted (dental) doctor's office, the previous period continues. If a contracted (dental) doctor does not provide proof of advanced training or does not provide it in full, the statutory health insurance (dental) medical association is obliged to pay the fee to be paid for the contractual (dental) medical work for the first four quarters following the five-year period to reduce 10 per cent, from the following quarter by 25 per cent. A contracted (dental) doctor can complete or partially complete the advanced training set for the five-year period within two years; The advanced training that has been made up is not counted towards the following five-year period. The fee reduction ends at the end of the quarter in which the complete training certificate is provided. If a contract (dental) doctor does not provide proof of advanced training at the latest two years after the end of the five-year period, the statutory (dental) medical association should immediately submit an application to the admissions committee to withdraw admission.
Dental quality management
From January 1, 2011, every contract dentist is obliged to maintain a quality management system (QM) in his practice. The basis for this is the QM guideline of the Federal Joint Committee (G-BA) on basic requirements for an institution-internal quality management in contract dental care from November 17, 2006, which in turn is based on § 135 SGB V. The dental associations have to monitor this.
Under quality management (QM) is to be understood of measures the continuous and systematic implementation, which sustained quality promotion and improvement is to be achieved. In concrete terms, quality management means that the organization, work processes and results of a dental practice or facility are regularly checked, documented and, if necessary, changed (quality cycle). The introduction and further development of an in-house quality management system serves to continuously secure and improve patient care and practice organization.
Dental quality assurance
Dental quality assurance consists of several components that are relevant for the contract dentist.
Cross-institutional and cross-sector quality assurance
In contrast to quality management, which mainly deals with the organizational processes in contract dental practice, the cross-facility and cross-sector quality assurance has been standardized in a further guideline of the Federal Joint Committee. This is then also binding for the contract dentist. The guideline for cross-institutional and cross-sector quality assurance according to Section 92 (1) sentence 2 no. 13 SGB V i. V. m. Section 137 (1) No. 1 SGB V entered into force on December 2, 2010.
With this guideline the legal requirements for the establishment of uniform quality standards in outpatient and inpatient care have been created. Treatment results can be recorded and assessed across sectors. The guideline describes the structures, in particular state working groups (LAG), that are required to implement cross-sectoral quality assurance, and defines the tasks of the organizations involved.
State working groups
State working groups (LAG) that have yet to be formed - consisting of the Association of Statutory Health Insurance Physicians , the Association of Statutory Health Insurance Dentists , the State Hospital Society, the associations of health insurance companies including the substitute funds - will in future take all important decisions on the implementation of quality assurance measures at the state level.
The introduction and implementation of the first cross-sectoral quality assurance measures are planned for 2017. The G-BA commissions an independent institute according to Section 137a SGB V ( Institute for Quality Assurance and Transparency in Health Care ) to develop quality indicators and the instruments of quality measurement and presentation for selected topics. The guideline was partially objected to by the Federal Ministry of Health.
Center for Dental Quality (ZZQ)
The Institute of German Dentists (IDZ) maintains a Dental Quality Center (ZZQ), which fulfills the task of processing questions relating to dental quality promotion, external quality assurance and the facility's internal quality management for German dentists. The ZZQ the Institute of German Dentists is a common means of German Dental Association - Association of the German dental chambers e. V. (BZÄK) and the National Association of Statutory Health Insurance Dentists K. d. ö. R. (KZBV).
Overall, the ZZQ deals with issues relating to the quality of structures, processes and results in dental work, including issues relating to advanced training, quality management systems, guidelines and quality indicators. One focus is the coordination in the creation of guidelines on diagnostic and therapeutic procedures in dentistry, their evaluation, dissemination and review. Furthermore, the ZZQ evaluates, reviews and evaluates external guidelines in terms of their importance for the development and updating of its own guideline concepts.
income
In the public discussion, there is often no distinction between sales of a dental practice, taxable income and disposable income. The statistical surveys of the National Association of Statutory Health Insurance Dentists (KZBV) on the average income of a dental practice owner provide information on the income situation.
| Ø Disposable income per practice owner 2011 | Germany |
|---|---|
| sales | € 407,392 |
| costs | € −276,981 |
| Income surplus ( median ) 1 | € 116,790 |
| Income tax, church tax, solidarity surcharge, social security | −46,140 € |
| Disposable income per year 2 | € 70,650 |
| Disposable income per month | € 5,887 |
| Weekly working hours | 47.3 hours |
| Net fee per hour | € 29.64 |
According to a study by the German Institute for Economic Research (DIW) from 2012, the average net hourly wage after graduation / training is € 12 for men and € 9 for women. The DIW study is based on data from the microcensus from 2005 to 2008. According to this study, the average “net wage” for dentists is € 19.33 and for female dentists € 15.50. (The average hourly wage was calculated using the maximum possible employment phase. For this purpose, the hourly wages for each age, occupation and training course were added up and compared with the maximum possible length of work (44 years)).
See also
Web links
Individual evidence
- ↑ Admission Ordinance for Dentists
- ↑ Federal Shell Contract - Dentists (BMV-Z) , § 9 Paragraph 3, National Association of Statutory Health Insurance Dentists , February 5, 2019. Accessed February 8, 2019.
- ↑ Section 103 (8) SGB V
- ↑ Article 6 Amendment of the licensing regulation for contract dentists
- ↑ BMG: basic tariff
- ↑ Article 44 Amendment of the Insurance Supervision Act (basic tariff)
- ↑ § 28 Abs. 2 SGB V exclusion of benefits
- ↑ Guideline of the Federal Joint Committee on the fundamental requirements for an institution's internal quality management in contract dental care (quality management guideline for contract dental care) (PDF) bzaek.de. November 7, 2006. Retrieved November 20, 2019.
- ↑ G-BA G-BA guidelines on QS
- ↑ BMG: notice of objection (PDF; 159 kB)
- ↑ Dental Central Office for Quality Assurance
- ↑ Statistical Yearbook 2013 National Association of Statutory Health Insurance Dentists (KZBV) ISBN 978-3-944629-01-8
- ↑ DIW, weekly report 13/2012 (PDF; 501 kB), Daniela Glocker, Johanna Storck, university, technical college or training, which subjects bring the highest wages?
