Inhaltsverzeichnis | Sommaire
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What is OKP approval?
The OKP license entitles medical service providers to bill their services via the compulsory health insurance. It is therefore a basic requirement for participation in the public healthcare system and ensures that the services offered meet national quality and safety standards.
The importance of OKP approval
The license not only serves as a formal authorization to bill for services, but is also a sign of quality. It signals to patients and insurance companies that the service provider meets the strict requirements of the Swiss healthcare system. It also enables access to a wider range of patients, as everyone in Switzerland is covered by basic health insurance.
Requirements for obtaining OKP approval
The Health Insurance Act (KVG) and the Health Insurance Ordinance (KVV) specify the admission criteria to be examined by the cantonal health authorities. The requirements for approval can vary depending on the canton and specialist area, but basically include the following:
1. professional license:
A central and first step is the acquisition of a cantonal license to practice the profession, which confirms that the service provider meets the legal requirements for practicing the profession.
Proof of specialist training and any necessary further training must be provided for this. This ensures that the service providers have the necessary specialist knowledge and skills to carry out their profession.
2. operating license
In order to provide outpatient medical services, a cantonal operating license must also be obtained. Different requirements and restrictions apply depending on the professional group and canton.
For this purpose
- Operating and business concepts
- Role descriptions
- Details of the premises
- Information on the quality assurance system
- Proof of insurance
and other evidence is required, which may vary depending on the canton and sector.
3. proof of compliance with the quality requirements (Art. 58g KVV)
Service providers must also prove that they can meet the following quality requirements:
- You have the necessary qualified personnel.
- The quality management system and all associated documents systematically define all quality management principles and procedures:
- Staff training and development
- Supervision of staff
- Error and complaint management (patient and staff-related)
- Quality circle
- Any quality label
- Hygiene
- These must be available to all employees in the form of directives and instructions and must be reviewed regularly.
- You also have a suitable internal reporting and reporting and learning system and, if such a system exists, have joined a uniform nationwide network for reporting adverse events.
The content is about:
- dealing constructively with errors and risks
- learn from mistakes
- Plan and support
- Create reliable structures and processes
- Defining the case processing procedure
- Ensure systematic analysis by trained personnel
- Ensure integration into clinical risk and quality management.
Ask your professional association about the possibility of joining a uniform nationwide network for reporting adverse events (such as the CIRRNET of the Swiss Patient Safety Foundation: About CIRRNET – Patient Safety) and inform the regulatory authorities of this.
The reporting and learning system | H-CIRS Starter | new-win (newwin.ch) from new-win fully meets the requirements listed here, including the connection to the national network CIRRNET of the Swiss Patient Safety Foundation.
- You have the equipment required to participate in national quality measurements.
Ask your professional association about the current status and inform the licensing authority.
You can also find detailed information on the quality requirements in our blog article KVG Article 58: Transparency in the Swiss healthcare system (newwin.ch).
And if you would like to find out more about CIRS and OKP, we recommend the blog post CIRS and OKP approval | new-win SW Solutions AG (newwin.ch).
Step-by-step instructions on how to apply
1. information procurement:
Each canton in Switzerland may have its own specific requirements and forms for applying for OKP approval. It is therefore important to find out about these in advance from the relevant cantonal health department.
Approval of outpatient service providers for OKP
2. prepare documents:
The application usually includes:
- Proof of license to practice the profession
- Proof of operating license
- A suitable reporting and learning system
- Other suitable QM instruments in accordance with cantonal requirements
3. submit application:
Once all the necessary documents have been collected, submit the application to the responsible health department. Some cantons also allow you to do this digitally.
4. processing time:
The duration of the procedure may vary. It is advisable to inquire about the average time frame for processing and to remain available during this time in case any queries arise.
5th decision:
After the examination, you will receive a decision. If you are approved, you are entitled to bill the OKP. If you are rejected, you should analyze the reasons and take appropriate steps to rectify the situation.
After approval
Billing with health insurance companies:
Find out from the various health insurance companies about the specific billing modalities and requirements.
Application for the paying agent register ZSR number:
ZSR numbers are used for simplified billing of benefits with all health insurers in Switzerland and the Principality of Liechtenstein. Fill in the application form on the SASIS AG website and refer to the information sheet for the issue of the ZSR number for your professional group(ZSR number application – SASIS). Once you have received the ZSR number, you are relieved of the need to provide proof of your license and qualifications to each insurer individually. The ZSR number must be shown on the invoice to patients or insurers.
The ZSR numbers are assigned to the canton in which benefits are provided. If services are provided in several cantons, a separate ZSR number must be applied for in each of these cantons. A corresponding cantonal authorization and admission to the OKP (compulsory health insurance) are prerequisites for obtaining the ZSR number.
Further training:
In order to continuously improve the quality of patient care and retain the license, regular participation in further training is required.
Quality management:
The implementation of a quality management system is not only necessary for licensing, but also increases the trust of patients/customers in your practice.
Frequent challenges
- Complex requirements and bureaucracy: The process can be complicated by complex requirements and bureaucratic hurdles. Careful planning and preparation are therefore essential.
- Long processing times: Due to the detailed review process, there may be long wait times. Patience and proactive communication with the responsible authorities can make the process easier.
- Incomplete documentation: One of the most common hurdles in the approval process is the submission of incomplete or incorrect documents. You should therefore check all documents carefully.
- Communication problems with authorities: Maintain contact with the relevant authorities and document all correspondence.
- Delays: Respond quickly to requests from the authorities so as not to delay the process unnecessarily.
Conclusion
OKP approval is very important for outpatient service providers in Switzerland. It not only allows them to bill via basic insurance, but also guarantees the high quality and safety of medical services. With careful preparation and knowledge of the procedure, interested healthcare providers can successfully master this important step in their professional career.
Our guide aims to make this important step easier for you, but does not claim to be exhaustive and is not intended to be exhaustive.
If you have any further questions, please do not hesitate to contact us. We look forward to helping you and introducing you to our products.
