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Evaluation Verification of DRG hospital invoices by health insurers - Appraisal of the changeover period prior to the new hospital financing

Audit number: 14367

SwissDRG (Swiss Diagnosis Related Groups) is the new tariff system for in-patient acute somatic hospital services. Invoicing in accordance with the SwissDRG flat-rate payment system has been used since 2012. From 2014, health insurers must have a data collection point certified by the Federal Data Protection and Information Commissioner (FDPIC) for processing medical bill information. It is basically too soon for an extensive analysis of SwissDRG invoice verification by the health insurers since no solid experience data is available. In spite of this, the Swiss Federal Audit Office (SFAO) has taken the decision to conduct an analysis within the current changeover period. The aim is to give a transparent picture of the current situation and point to any problems or critical areas so that possible improvements can be made at an early stage.

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