Increase factor goä

The doctor determines which factor is appropriate. More difficult or more time-consuming than the "average case" leads to billing with higher factors; if it was particularly easy, a lower factor is also appropriate The respective reason for a higher factor must match the content of the service. If one does not want to bill schematically with 2.3 or 1.8 times factors, then it helps to know that the 2.3 or 1.8 times factor is appropriate if the service was provided "as average".

The analogous comparison to the GOZ: In § 5 of the German Dental Fee Schedule (GOZ) of 1. 1. 2012 the following is stipulated: "The 2.3-fold fee rate represents the average performance according to difficulty and time expenditure; exceeding this fee rate is only permissible if special features of the assessment criteria mentioned in sentence 1 justify this. It is justified to transfer this provision to the GOÄ. The fact that the GOÄ does not contain such a definition can be attributed to its date of origin in 1996. The GOÄ, unlike the GOZ, has not been adapted since 1996.

Assessment criteria: The assessment criteria are "difficulty and time required for the individual service and circumstances during its execution". These are the same as in § 5 GOÄ! The GOZ and GOÄ also continue to be congruent: "The difficulty of the individual service may also be based on the difficulty of the case of illness. Sentence 1 of § 5 Abs. 2 GOÄ reads: "Within the framework of the fees, the fees are to be determined according to equitable discretion, taking into account the difficulty and the time required for the individual service as well as the circumstances of the execution. From this the request can be derived to determine the factor "within the fee framework" - i.e. between the simple rate (1.0-fold) and the respective maximum rate (3.5 or 2.5-fold). Since the performance is not always "average", it is the declared intention of the GOÄ to determine factors other than the threshold values.

Furthermore, the GOÄ supports the physician who bills with differentiated factors adapted to his actual performance by saying "at his reasonable discretion". Here "cheap" means "right and fair", i.e. appropriate. And whether the service provided was average or deviated from this can only be assessed by the physician himself, not by the clerk of a cost unit.

Important for the enforceability of the higher factor in a dispute is the documentation. The performance of services deviating from the "average case" must be documented!

The term "at reasonable discretion" makes it clear that there may also be intermediate steps in the assessment of the factor. If a benefit was only "somewhat more difficult", it may not be the maximum rate that is appropriate, but a 3.2-fold factor, for example. It is also logical that if the performance was particularly easy, a factor below the threshold value is also appropriate, e.g. instead of 1.8 times, only 1.3 times.

The criteria to be applied by the physician when measuring the factor "difficulty and time required" are self-explanatory. Circumstances during execution" refers to other circumstances that cannot be measured in terms of difficulty and time expenditure, such as the provision of services under adverse external circumstances, special methodological circumstances or special wishes of the patient.

Even the "difficulty of the case of illness" can be a permissible reason for applying a higher factor. Difficult cases of illness are not only those of serious diseases, the "case of illness" can also be difficult due to its complexity (overlapping presence of several diseases) or an atypical course of the disease.

It should be noted that the provision refers to the "single benefit". Thus, there is no single factor increase rationale that applies to all benefits. The content of the factor increase must be appropriate to the respective service. For example, a justification such as "complex clinical picture" fits consulting services, but not, for example, a blood test or dressing.

1. www.Abrechnungstipps.de