The introduction of the new Swiss ambulatory tariff systems – TARDOC and ambulatory flat rates – significantly increases the requirements for billing, coding and service grouping in Swiss hospitals. Existing system landscapes and established billing processes need to be adapted to new tariff requirements.
d-fine Switzerland supports hospitals in this transition phase with Octopus, a specialized software solution for automated billing preparation. Octopus supports compliance with tariff requirements, reduces manual effort and helps hospitals ensure the continuity of their revenue cycle during the tariff transition.
The challenge for Swiss hospitals
With the new ambulatory tariff landscape, services from different clinical systems need to be consolidated into tariff-relevant patient contacts. ICD-10 diagnoses must be validated, completed and assigned to the relevant sessions. Session IDs and reference session IDs must be generated consistently to enable a smooth import into the billing system.
Existing legacy systems do not always fully cover the logic required for this. This can lead to manual corrections, increased workload, delayed billing, import errors and compliance risks. Disruptions in the billing process can therefore result in revenue risks, administrative inefficiencies and regulatory uncertainties.
The Octopus solution
Octopus was developed specifically for the Swiss market and is designed to support ambulatory billing under TARDOC and ambulatory flat rates. Octopus acts as an intermediary system between the hospital’s source systems and its billing systems. The solution receives clinical and administrative data, applies the required ambulatory tariff logic for service grouping, validates the completeness and correctness of ICD-10 diagnoses, and exports tariff-compliant sessions for billing.
Octopus can be integrated into existing hospital and billing system landscapes via established data exchange formats such as XML files, including ALIS-like files, as well as HL7 ADT messages. The solution can be operated on-premise, ensuring that sensitive hospital data remains within the hospital’s infrastructure.
Productive use at Kantonsspital Baselland
Octopus has been in productive use at Kantonsspital Baselland (KSBL) since March. Since go-live, the system has processed more then 2 million ambulatory services and enabled KSBL to start ambulatory billing significantly earlier than many hospitals facing comparable transition challenges.
Building on an initial MVP, Octopus was further developed in close collaboration with KSBL into a robust, rule-based application designed for reliability and performance in high-volume hospital billing.
Stefan Beyeler, implementation lead on the KSBL side, highlights the key contributions of Octopus:
- correct representation of sessions in accordance with the requirements of the tariff system, including the consolidation of services from one or more source systems
- validation and completion of ICD-10 diagnoses for identified sessions and grouping of services
- automated processing and forwarding of 90–95% of services to the billing system, with manual intervention only required where professional assessment is necessary
In addition, Octopus includes an integrated internal control system that supports consistent data flow across import, processing and export, helping to prevent data loss, duplication or alteration.
From innovation challenge to productive solution
The Octopus project originated from an innovation challenge organised by DayOne, supported by Innosuisse. The initial focus was on AI-supported quality assurance and completeness validation. Building on this, d-fine Switzerland developed a productive, rule-based solution for ambulatory billing under the new Swiss tariff systems.
Octopus thus provides a foundation for further automation steps and can be extended in the future with additional functionalities, including AI-supported review and decision-making processes.
We are happy to support you in your tariff transition
With Octopus, Swiss hospitals can ensure the continuity of their revenue cycle, reduce administrative effort and achieve tariff-compliant ambulatory billing under TARDOC and ambulatory flat rates.
Please contact us for more information about Octopus and our support in introducing the new ambulatory tariff systems.
