For HospitalsRecord-based billing

Billing starts with a traceable record.

Billing private medical services from a patient record requires the documented services and their evidence to be brought together. aiomics currently supports record preparation and comparison of drafts with their sources. Further coding and German medical fee-rule support is in development. We clarify the available scope and handover to your billing team using your cases.

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Why the stack grows

Record-based billing brings together documented services from admission findings, operation and anaesthesia reports, progress notes, consultations and discharge letters. Different document types and inconsistent filing increase search and review effort. Missing records and unresolved questions can delay an invoice. An organised record helps billing staff review the available evidence and raise specific questions.

German medical fee schedule (GOÄ), § 12 — when payment falls due

§ 12 (1)Under § 12 (1) of the German medical fee schedule, remuneration becomes due once an invoice complying with the regulation has been issued.GOÄ § 12 (1)

3 yearsThe standard limitation period under § 195 BGB generally applies. Its start, expiry and potential objections require legal assessment for the particular case.§ 195 BGB; Federal Medical Association, fee-schedule guidance

ForfeitureForfeiture may be relevant separately from limitation. Both the duration of the delay and further circumstances of the individual case matter. Timely invoicing makes outstanding questions easier to resolve.Federal Medical Association, limitation and forfeiture

Per serviceUnder § 12 (3) of the German medical fee schedule, exceeding the applicable threshold requires an understandable and traceable written explanation for the individual service. Thresholds differ by service category.GOÄ § 12 (3), § 5 (2)

The service, its evidence and any required justification need to fit together. An organised record makes review easier: what was documented, where is it, and what question remains open? The responsible professional assesses whether the available information supports the billed service and its multiplier.

GOÄ § 5 (2) sentence 4 — the standard range and exceeding 2.3×

From the record to billing preparation

Record preparation is available. The following coding and fee-rule steps describe the planned extension and its professional review.

The record becomes readable

Scans, dictations, forms and printouts are taken in, assigned to document types and put in order: admission, operation, anaesthesia, progress, consultation, discharge. Before that the record is a stack; after it, a case.

Review proposals against evidence

The planned coding support is intended to connect proposals with available source passages. The responsible person checks whether the passage supports the proposed item. A missing passage calls for clarification; it establishes neither that a service was performed nor that it was omitted.

Check defined fee rules

Rule-based checks are planned for defined exclusions, timing conditions, frequency limits and reductions. Their scope, rule version and results must be reviewed before use. The responsible professionals retain the legal and professional assessment of the individual case.

Review draft justifications against sources

A draft justification is intended to bring together the available documentation in a traceable form. Source references support comparison with the original records. The responsible professional corrects unsupported or inaccurate statements and decides whether the justification is sufficient for the individual service.

Review before invoicing

Authorised people review billing before an invoice is issued. Responsibilities, handover and documentation of that review are defined with the hospital. Technically enforced multistage approval is one possible configuration of the process.

Development connects preparation of existing documentation with defined rule checks. Functional scope, failure cases and professional review responsibilities are agreed for a deployment.

Planned: feedback from billing

Open evidence questions are intended to return to the responsible documentation team: which evidence is missing from the supplied records, and which statement is inconsistent? The question concerns the documented information. The responsible person clarifies whether a service was actually performed.

The planned feedback is intended to make clarification easier while a case is open. The hospital can also use it to improve documentation of future cases. Later additions must reflect what actually happened and comply with the applicable documentation requirements.

Analysis of recurring evidence questions by department, objection type and document type is planned. Analysis rules and denominators will be defined explicitly. Whether this reduces follow-up questions or processing time must be measured in the particular deployment.

Handing over to billing

Prepared records and drafts go to the responsible billing team for professional review. Scope, format and transfer route are agreed for the particular deployment.

To your own private-billing team, in the agreed format and with the required documents
To your billing service provider once format, responsibilities and transfer route are agreed
With the information needed to review the inpatient reduction under § 6a of the German medical fee schedule; the billing team checks how it appears on the invoice
With the agreed documentation of source passages, open questions and processing steps

Responsibility for the invoice stays with the hospital, or with the physician entitled to bill. We transmit nothing to insurers or patients.

Keep rule versions traceable

Changes to medical fee rules can change the required information and justifications. The planned coding support therefore needs identified sources and rule versions.

Before changed rules are adopted, their scope, effective date and impact on affected cases must be reviewed. Draft proposals and rules in force must remain clearly distinguishable.

We clarify which rules matter to your billing process and which support is available or planned. Prepared documentation remains the foundation for professional review.

Federal Medical Association, information on the fee-schedule reform

Review and responsibility

Authorised people review items and justifications before invoicing. Technically enforced multistage approval can be agreed separately.

Draft justifications are created from the supplied chart. Source references and gap flags support review. Because AI can also generate unsupported statements, the responsible professional checks every draft against the original records.

The planned coding support processes already documented information for administrative billing. Diagnosis, treatment and patient assessment remain the responsibility of the relevant professionals.

Transfer of billing data follows the agreed process and the hospital’s approvals. Further coding and checking methods, including OPS-related functions, are planned; this does not establish available transmission under § 301 SGB V.

The described use supports administrative documentation and billing work. Observations concern existing evidence and its traceability. The intended functional scope undergoes regulatory review before development; supporting documentation is available on request.

What runs today, what follows

Where each part currently stands. This overview is kept up to date.

In use

Making records readable

Bulk upload of whole document sets, assignment to document types, a timeline across the case, the source shown beside every adopted entry. Shipped and in operation.

In development

Coding and fee-rule checks

Further coding proposals, source-based review and defined billing-rule checks are planned. The scope and development status are established before an evaluation. A production-ready German medical fee billing process is not promised here.

Planned

Feedback and analysis

Gap notices sent back to documentation while the case is still open, structured storage of the findings, and the monthly analysis by department, objection type and missing document type.

Watched

Changes to rule sets

Changes to relevant fee and coding rules are considered in the design. The scope, applicable rule version and timing must be established for each function.

Legal framework and data processing

Patient data is processed within the European Union. Data flows, service providers and contractual processing and confidentiality arrangements are documented for the agreed deployment.
Information security to ISO/IEC 27001, certified by TÜV Nord. The German cloud-security catalogue at type 2 level is in preparation for our own operation; we do not rely on the data-centre operator's attestation for it.
Quality management system aligned to the principles of ISO 13485, with the regulatory qualification documented before any function is developed.
Rulebooks accounted for: the medical fee schedule (in particular §§ 5, 6a, 12), § 17 of the Hospital Remuneration Act for optional services, §§ 195 and 199 of the Civil Code on limitation, and § 301 Book Five of the Social Code for data exchange with statutory payers.
Templates for the data processing agreement and the data protection impact assessment are part of the delivery; a works council information pack is available.
Preparation for the requirements of the EU AI Act. AI-supported proposals and draft text are labelled, and AI literacy training for hospital staff is part of the delivery.

Frequent questions

We have a billing service provider. Are you competing with them?

Your existing billing team or provider can continue working with the prepared records. Together we clarify which preparation functions are available today and which planned support would be relevant to your process. Format, responsibilities and handover to the provider are agreed for the particular deployment.

How old can the records be that we have worked up?

Preparation depends on the readability, completeness and format of the records. Older cases also require an assessment of limitation and possible forfeiture. Your legal advisers perform that assessment; the prepared records support their review.

Who reviews the items before invoicing?

The authorised people review the billing and its supporting evidence. Responsibilities for professional review are defined in the process. Liability depends on the contracts and applicable law; this page does not allocate liability.

How do open evidence questions help?

They identify information that the responsible person still needs to review or clarify. A missing source passage does not automatically determine whether a service can be billed. For the planned coding support, the observations and their limitations will be evaluated using concrete cases.

Do you point a language model at fee law?

For the planned coding support, language-based preparation and defined rule checks are considered separately. The scope defines and evaluates which rules can be checked automatically and which questions require individual assessment.

What happens to our data?

Patient data is processed within the European Union. Technical and contractual documents describe the service providers and data flows. Templates for data processing agreements and data protection impact assessments support your hospital’s review.

Should we wait for the new fee schedule?

A decision should consider the rules currently in force and the functions required. Record preparation can be assessed independently of future fee-rule changes. We distinguish available functions, planned extensions and unresolved rule changes in the discussion.

How do we start?

With completed cases from your own hospital where there was a challenge. They show what a proof of origin does and what it does not — including if you end up staying with your current process.

A look at your stack

We review a few completed cases and your existing process. Together we clarify the effort spent finding documents and resolving questions, the functions currently available and possible next steps.

Arrange a conversation

One hour. No obligation. Substantive, not a sales pitch.