Honorarausschöpfung: billing everything you already documented

By Honorarausschöpfung we mean one thing: billing completely for the services your practice has already performed and documented. Not billing more. Not billing differently. Closing the gap between what the note supports and what is actually billed.

This gap doesn't show: the service is in the documentation, the matching code never gets entered, and nothing flags it. This page explains where the gap comes from, where it can open, and what actually closes it.

Why documented services go unbilled

The daily reality first: the long conversation about a new diagnosis, the chronic care visit, the wound care. Done, documented, and then the next patient was already waiting. The code entry is the step that loses.

Then the system reality: what was never entered is in no claim, and it is the claim that gets checked.

Where gaps can open

In EBM, some items have a condition that only builds up over time: the problem-oriented consultation (03230) per completed ten minutes,¹ the surcharge for treating chronically ill patients (03220), which requires contacts for the same chronic condition in at least three of four quarters,² and the treatment of wounds healing by secondary intention (02310) with at least three doctor-patient contacts in the treatment case.³ In GOÄ, a fee above the threshold has to be justified in writing: above 2.3 times the rate, or above 1.8 times for services under § 5(3) and 1.15 times under § 5(4).⁴ What these EBM items require in detail is in our overview of forgotten billing codes; how to justify GOÄ factors is in our article on GOÄ factors.

Measuring Honorarausschöpfung: how to see your own gap

The only way to see your own gap: for one quarter, compare the notes with the billed codes and count the divergence. Manual, tedious, revealing. Our own measurement will count something else: how often doctors approve meda's suggestions, not the size of the gap. How we measure is in our method.

Three ways practices close the gap

Two ways are well known: self audits and billing training. And there is a newer, third way: the billing-completeness layer above the PVS. Software that reads the finished notes and suggests the billing codes they support, for the doctor to approve.

How meda does it

meda reads the documentation that came out of the consultation and surfaces the codes it supports, each with the sentence of the note that backs it. The doctor decides on every code: approve, delete or mark as unsure. Nothing enters your PVS unless you approve it.

What this means for the Plausibilitätsprüfung

Complete EBM billing has to be ready for the KV's Plausibilitätsprüfung. The KV checks in particular the volume of services billed per day against the doctor's time.⁵ The basis is the review times (Prüfzeiten) in Annex 3 of the EBM, evaluated as a daily and a quarterly time profile.⁶ Additional services billed that carry a review time therefore add to the quarterly profile and, where subject to the daily profile, to that one too; services in the organised emergency service, for example, are excluded. Every approved code keeps its link in meda to the place in the note it came from and to the diagnosis (ICD-10-GM) that supports it. Correct billing, evidenced — not gaming it.