Inspection of health insurance company data collection points

As already mentioned in the 2014/2015 annual report, since 1 January 2014 all health insurance companies have been required to have a certified data collection point to receive diagnosis-related-group-type invoices. Our inspections of data collection points this year have revealed that the system has been well implemented. In some cases we identified weaknesses, of which the certification agencies concerned have been made aware.

In the reporting year, we inspected seven certified data collection points. Interfaces to various other players were also tested (e.g. the interface between intermediary and data collection point). In these inspections we mainly identified the same problems as those found the previous year. Please therefore refer to section 1.6.1 of the 22nd annual report for more details.

In the course of the reporting year, we once again held several coordination meetings with the Federal Office of Public Health (FOPH). The aim of these meetings was to coordinate any overlapping supervisory activities between the two authorities and to discuss any issues regarding the data collection points and related matters that were still unclear.

Meetings were also held with the data collection point certifiers and the Swiss Accreditation Service (SAS), which once again provided an occasion for a constructive discussion on the certification, implementation and function of the data collection points, interfaces between the various players (hospitals, intermediaries etc.) and to iron out differences of opinion.

In retrospect we can say that Article 59a of the Health Insurance Ordinance continues to be successfully and for the most part correctly implemented. Cooperation with the certifiers, insurers and operators of electronic data collection points was highly constructive.

https://www.edoeb.admin.ch/content/edoeb/en/home/documentation/annual-reports/23rd-annual-report-2015-2016/inspection-of-health-insurance-company-data-collection-points.html