Corpus Callosum Corpus AbrechnungBilling audit for general practitioner practices

Recourse & Examination

Help with recourse claims from the examination body or health insurance companies

If the joint examination body or a health insurance company threatens or asserts a claim for recourse, we will keep track of everything with your family doctor's practice: documents, deadlines and a factual statement - without empty promises and without legal advice.

  • § 106 SGB V · Examination office
  • Drug and therapeutic recourse
  • Mon-Fri 8:30–17:30 p.m
Doctor with lots of documents – quarterly billing at a glance

What it's about

Claims for recourse can be verified - better prepared than waited

Performance audits and recourses in accordance with Section 106 SGB V are carried out by the joint audit bodies of the Association of Statutory Health Insurance Physicians and health insurance companies. Inquiries and claims can also come from health insurance companies. Typical topics are regulations (e.g. medicines or remedies) or billing patterns. Deadlines are running, documents must be correct, and a statement should be medically and documentarily sound. We provide you with professional support in the preparation - legal representation remains with lawyers where necessary.

Analysis of the documents

We look at notifications and cover letters from the examination body or health insurance companies, relevant prescription and billing data as well as your documentation - as long as you provide them to us in accordance with data protection regulations.

  • Classification: What is complained about, what period, what basis in the cover letter from the examining body or health insurance company?
  • Comparison with your documents and typical subject group-specific samples
  • Plain language: where arguments can be effective – and where the situation is tight

Deadlines and next steps

We mark the deadlines mentioned in the letter and help you determine the order of the to-dos. We will discuss whether an objection, statement or query makes sense based on your documents - without a blanket promise of success.

  • Make deadlines visible in the letter
  • Prioritized checklist for the practice and doctor
  • Coordinate when external legal advice makes sense

Prepare a statement together

We work with you to develop the technical arguments and the documentary basis for a statement. You remain responsible for the content; We structure, formulate and check for completeness.

  • Factual structure instead of empty phrases
  • Reference to documentation, indications and guidelines, if available
  • No made-up numbers, no guarantee statements

Prevention: bill and document correctly

Many checks can be defused before they begin: through comprehensible digit selection, clean documentation and attention to conspicuous prescription and billing patterns. This is part of our ongoing billing audit.

  • Advice on risky patterns before the end of the quarter
  • Documentation checklists for critical services
  • Training your team in the areas that really matter to you

Clear framework

What we do – and what we don’t do

We support

  • Technical analysis of recourse and audit documents
  • Support in preparing statements together with you
  • Information on deadlines and organizational next steps
  • Preventive checking of billing and documentation

Not included

  • No legal advice and no representation before courts or authorities
  • No guarantee for a specific exam result
  • No made-up metrics or success rates

Where legal advice is necessary, we will work with the lawyers you have appointed or recommend that you seek legal advice.

Have you received a letter from the examination office or health insurance company?

Please tell us briefly about the status of your family doctor's practice - we will contact you during business hours Mon-Fri 8:30–17:30. We offer billing audits at the end of the quarter at fixed prices; We mention amounts in conversation.