Compliant Hospital Billing

At KSBL, Octopus has already processed more than 2.5 million ambulatory services since March 2026 – with around 12,000 additional services being processed every day. Approximately 90–95% of tariff sessions are handled automatically, supporting earlier billing, reduced manual effort and compliant processing under the new Swiss ambulatory tariff regime.

With the introduction of TARDOC and ambulatory flat rates, KSBL needed to adapt established billing processes to a new and significantly more complex tariff logic. Manual workarounds would have increased administrative effort, delayed billing and created compliance risks. KSBL therefore required a robust, auditable and production-ready solution capable of processing high service volumes while supporting billing continuity, operational control and regulatory compliance during the tariff transition.

d-fine Switzerland implemented Octopus as an intermediary system between clinical source systems and the billing system, enabling automated grouping, ICD-10 validation, tariff session ID assignment and export of billing-ready tariff sessions. 

Stefan Beyeler, External Consultant & Implementation Lead at KSBL

Octopus enabled us to start outpatient billing with TARDOC and outpatient flat rates significantly earlier than many hospitals facing a comparable transition without interrupting our ongoing inpatient billing operations. Today, the processing of service data and the validation of the ICD-10 diagnoses entered by physicians are transparent and traceable processes – we can see at any time where a case stands and why.  

At KSBL, Octopus consolidates ambulatory service data from eight source systems into tariff-relevant patient contacts. Around 17% of tariff sessions include services from more than one source system. For 37% of tariff sessions, services are received in multiple files submitted on different dates. Octopus applies rule-based grouping logic to bring these inputs together and prepare tariff-compliant sessions for billing export.

Ambulatory services are often documented across multiple clinical, departmental and administrative systems. Under the new tariff regime, these services must be grouped into one tariff-relevant patient contact before billing – even when they come from different systems or arrive over time. Manual consolidation increases workload, delays billing and creates risks of import errors or compliance gaps.

For KSBL, Octopus provides confidence that related ambulatory services are consistently brought together into the correct tariff-relevant patient contact, regardless of the originating source system or the date on which the data is delivered. This creates a reliable link between clinical documentation and billing, reducing manual effort and supporting stable, tariff-compliant processing at high volumes.

Octopus validates ICD-10 codes automatically for all relevant tariff sessions as part of the billing preparation process. At KSBL, several scenarios require additional validation logic: around 3% of tariff sessions are assigned to ambulatory flat rates and are therefore particularly sensitive to ICD-10 coding; around 9% require validation against services archived at different points in time; and around 28% require checks to ensure ICD-10 code alignment across multiple tariff sessions taking place on the same day. These categories may overlap. All checks are performed automatically. Only cases with inconsistencies, missing information or need for professional assessment are flagged for user review – currently around 5-10% of tariff sessions.

The new Swiss ambulatory tariff landscape makes complete, consistent and correctly assigned ICD-10 diagnoses essential for compliant billing. Missing or incorrect ICD-10 codes can cause clarification loops, billing delays and compliance risks. Hospitals therefore need a controlled process that validates diagnosis information early, flags sessions requiring review and provides clear explanations before billing export.

For KSBL, Octopus provides confidence that ICD-10 information is validated consistently across tariff-relevant sessions, including cases with archived services or higher sensitivity under ambulatory flat-rate logic. Explainable flags help users understand why a session requires attention and support targeted correction directly in the workflow.

All data processed by Octopus passes through the integrated Internal Control System (IKS). The IKS results are reviewed daily by the hospital, enabling early detection of potential issues and timely correction where needed. The on-premise implementation and hospital-controlled database access ensure that sensitive data remains within KSBL’s own infrastructure and under the hospital’s control.

In high-volume billing processes, hospitals need confidence that all received data is processed correctly, completely and transferred reliably to the billing system. At the same time, sensitive patient and billing data must remain protected and under the hospital’s control. Hospitals therefore require a solution that combines automation with transparency, auditability, secure operation and strong data sovereignty within the existing IT landscape.

For KSBL, the integrated IKS provides daily control over the billing preparation workflow and helps verify that data is imported, processed and exported correctly. The on-premise deployment is key to maintaining data sovereignty, ensuring that sensitive patient and billing data remains within the hospital’s own infrastructure and under its control.

Stefan Beyeler, Project Manager & Consultant, Implementation Lead at KSBL

The integrated internal control system gives us continuous visibility into the data flow rather than providing only a retrospective view. Potential issues become visible while they can still be corrected, rather than weeks later during the billing process. This allows us to document our data-flow management requirements in a structured way. The on-premises setup was a deliberate decision: patient data remains within our own infrastructure, ensuring that operational control and data sovereignty remain clearly with the hospital.