Target performance principle
The target performance principle is a term from the private fee schedule for doctors (GOÄ) or the private fee schedule for dentists (GOZ) and aims to avoid double fees for medical services. In principle, the fee schedules contain individual services that are to be remunerated individually. A doctor's bill or dentist's bill is almost always made up of such individual items in the fee schedule. The classification of the billable services becomes difficult if they overlap in terms of content. In these cases, the service that is in the foreground is invoiced.
The remuneration for surgical treatments is also made up of individual services. However, the summary billing of individual services is restricted by the target service principle.
Relevant is § 4 Para. 2a GOÄ, which states:
“The doctor cannot charge a fee for a service that is part of or a special implementation of another service according to the schedule of fees if he charges a fee for the other service. This also applies to the individual operational steps that are methodically necessary to provide the operational services listed in the schedule of fees. "
The emphasis here is on the methodologically necessary individual operative steps .
In Section 4 (2) GOZ, which has been in force since January 1, 2012, it says more precisely:
“The dentist cannot charge a fee for a service that is part of or a special implementation of another service according to the schedule of fees if he charges a fee for the other service. This also applies to the individual operational steps that are methodically necessary to provide the operational services listed in the schedule of fees. A service is a methodologically necessary component of another service if its content is included in the service description of the other service (target service) and has also been taken into account in its evaluation. "
Numerous judgments were made to determine the GOÄ. In 2008 the Federal Court of Justice ruled :
"The question of whether individual services are methodologically necessary components of the target service specified in the respective service description in the sense of Section 4 (2a) sentence 2 GOÄ and paragraph 1 sentences 1 and 2 of the general provisions of Section L cannot be answered accordingly, whether they are necessary in a specific individual case according to the rules of medical art so that the target service can be achieved. Rather, when applying an abstract, general standard, due to the billing purpose of these provisions, the content and systematic context of the fee items in question must be observed and their evaluation must be taken into account. "
The interpretation problems were not reduced by the BGH ruling. If a judicial review is to be carried out in individual cases as to whether different medical services are ( methodologically necessary ) components of another service in order to avoid double remuneration, the respective scope of services must be clear beforehand. This task, which is incumbent on the judge, can usually not be carried out without the help of a medical expert by means of a fee report . As usual, the judge has to use an abstract, general standard. The clarification in the (more recent) GOZ, in which the tenor of this BGH judgment was ultimately adopted, will also be helpful in legal proceedings in the medical field. It says there that a service is a methodologically necessary component of another service if its content is included in the service description of the other service (target service) and has also been taken into account in its evaluation.
Individual evidence
- ↑ BMJ, GOÄ
- ^ BMJ, GOZ
- ^ Judgment of the 3rd civil senate of the BGH of June 5, 2008 - Az: III ZR 239/07 (continuation of the judgments of the Senate BGH, May 13, 2004, III ZR 344/03, BGHZ 159, 142 and of March 16, 2006, III ZR 217/05, NJW-RR 2006, 919)
- ↑ BVerwG, judgment of September 21, 1995 - 2 C 33/94 - juris Rn. 14-16.
