Apothekenrechenzentrum

The Apothekenrechenzentrum sits between a pharmacy and the statutory payers. Individual pharmacies do not invoice individual Krankenkassen. The claims of a settlement period are delivered to the settlement house, which sorts them by payer, checks them for the formal errors that would otherwise cause a rejection, submits them and pays the pharmacy. Naming the function matters more than naming the companies, because every pharmacy uses one and the mechanism is the same wherever the contract sits.

Three things happen there. The first is aggregation, since prescriptions, the Packungsfixum earned on them and claims for a pharmazeutische Dienstleistung submitted on a Sonderbeleg all arrive as one stream and leave sorted by payer. The second is the formal check, which is a narrow thing. The settlement house looks at whether the claim is complete and internally consistent, not at whether the service was pharmaceutically sound. The third is the money, and this is where the settlement house earns its keep, because it pays the pharmacy on a predictable cycle rather than leaving the pharmacy waiting on each payer. Deductions are applied here too, including the Kassenabschlag, and it is worth remembering that any increase to that Abschlag rides on a separate law and not on the ApoVWG.

What it does not handle is the more useful half of the answer. The settlement house does not decide whether a service is claimable, it does not set prices, it does not carry the pharmacy's documentation duties and it does not resolve a Retaxation on the pharmacy's behalf, although it passes the correspondence through and usually supports it. Above all it has no role at all in self pay revenue. Where the customer pays for a service directly, the pharmacy issues its own invoice in its own name, collects the money itself and books it itself. That is ordinary Privatliquidation, and nothing about the transaction is submitted anywhere.

For a pharmacy planning a paid diagnostics offer this is the cleanest way to see the difference between the two revenue lines. One line is settled through an external house on a fixed cycle with fees set outside the pharmacy. The other is invoiced, collected and reconciled in house, which means the pharmacy carries the payment risk and also the VAT question, and that question depends on what exactly was performed and belongs with the pharmacy Steuerberater before the first invoice is written.