All information about the arrangement model

Most health insurance companies will inform you of the further procedure when they receive the cost approval. The PsyG only specifies the procedure up to the 30th session. How the health insurance companies proceed from the 30th session onwards is very individually tailored to the patient. If the health insurance company has not sent a specific procedure, you must ask them directly.

The Federal Office of Public Health (FOPH) writes on request: "The cost approval from the 'old' health insurance company is not binding for the new insurance company. The patient must apply again to the new insurer for approval of costs."

The patient has to do this and the psychiatrist or psychologist is often only consulted if necessary.

Yes, from now on, billing via the supplementary insurance (VVG) is also possible with a ZSR number possible. This can be ordered at SASIS be requested by means of this form. Newly it can bebe selected whether via the ocompulsory health insurance (OKP) or is billed via the supplementary insurance (VVG). Both both together is still not possible. Due to the fact that the psychotherapy as of 01.07.22 defined as a primary benefit, supplementary insurances are probably will probably adjust their benefits catalog to the year 2024. We therefore recommend contacting the respective supplementary insurance and obtaining a cost approval.

This is only an interruption and the therapy will obviously continue.

In this context, it also seems irrelevant whether the hospitalization is for an accident, a somatic ailment or for the psychotherapeutically treated illness (and whether psychotherapeutic treatment was possibly also provided in the hospital). Even after a change of year, a vacation of the patients or other circumstances, the therapy would not "start from scratch" again.

Before continuing beyond a total of 30 sessions (in this case 14 before hospitalization + 16 after hospital discharge), health insurance must approve the continuation.

A referral/order for psychotherapy made by name for a specific therapist could possibly be criticized by the patient's health insurance when reimbursing the services provided by another person and thus lead to problems. The ordering physician could issue a follow-up order. It makes sense for the ordering person to remain closely involved and informed, even if there is a change of therapist.

It is not always necessary to order 15 sessions. It is also possible to order fewer sessions, for example, 2-3 sessions at the beginning, then 10, then 8, and so on. Or start via short therapy with an order from a gynecologist etc., later the family doctor takes over the orders of 10+10 sessions.

In this respect, there can also be a third or fourth order. However, before continuing beyond 30 sessions, the approval of the health insurance company is required.

Answer: The order must have been obtained before the initial consultation. For the continuation of psychotherapy after 15 sessions, a second order from the ordering physician must be available. Likewise, for the continuation after 30 sessions, the cost approval of the basic insurer must be available. In summary: Without a valid order, no services may be provided!

Answer: After the 1st order, which is valid for 15 sessions (or for 10 sessions as crisis intervention or brief therapy), a 2nd order can be requested approximately after the 13th session with the same ordering doctor. If the psychotherapy has been carried out with an order for 10 sessions (this can be issued by any doctor with specialist training), a proper order must be obtained after this number of sessions (or shortly before). Here are the forms in D / F / It.

If, after approximately 26 sessions, it is determined that it would be appropriate to continue psychotherapy, another form must be used. You can either send it directly to the psychiatrist assessing the case, or you can send it to the ordering doctor: D / F / It. You have to fill in the first part of the form, the ordering doctor fills in the cover sheet. You can leave the second part of the form to the specialist.

The ordering physician then submits the request, together with the psychiatrist's case assessment, to the health insurance company. The health insurance company undertakes to inform the insured person within 15 working days of receipt of the report to the medical examiner whether and for how long the costs of psychotherapy will continue to be covered. A copy will be sent to the ordering physician.

Answer: Before psychotherapy can be continued after 30 sessions, the insurer must approve the costs. This is regulated in Article 11b paragraph 3 KLV.

This also applies to the continuation of psychotherapy that began as crisis intervention or brief therapy and continued with a regular arrangement. After a cumulative total of 30 sessions (10 sessions of brief therapy/crisis intervention + 20 sessions via regular arrangement), a cost approval from the insurer is required.

The report with the proposal for continuation must be drawn up by the ordering doctor. In the case of psychological psychotherapy prescribed by specialists in general internal medicine or pediatrics and adolescent medicine, this report must include the result of a case assessment by specialists with the advanced training titles of psychiatry and psychotherapy or child and adolescent psychiatry and psychotherapy.

Depending on the patient's individual vulnerability, this case assessment can also take the form of a file assessment.

No additional case assessment is required for psychotherapy prescribed by specialists in psychiatry and psychotherapy or in child and adolescent psychiatry and psychotherapy or with an interdisciplinary specialization in psychosomatic and psychosocial medicine SAPPM.

Since January 1, 2023, doctors with a degree in psychosomatic and psychosocial medicine have also been able to extend psychological psychotherapy beyond 30 sessions without having the case assessed by a psychiatric specialist.

Answer: On the doc24.ch platform, you can filter by canton and specialty. If you click directly into the profile of the specialist, you will see a note on the right side of the screen: "Orders/case assessments for psychological psychotherapy on at red light".

Answer: Actually not, but to be on the safe side, the SBAP recommends obtaining a brief confirmation of the authorization to prescribe in the medical professions register. Under the column "Further training" must be "General internal medicine" or "(Child and adolescent) psychiatry and psychotherapy" or "Child and adolescent medicine". This, for an ordering authority of 15 sessions. A possible additional qualification of the SAPPM can probably only be found on the website of the physicians concerned. This also authorizes the ordering of 15 sessions. All primary care physicians (including general practitioners) are authorized to order 10 sessions in emergency situations or crises.

Answer: It starts "all over again" for each patient from 1.7.22 onwards. There must be one order per patient. As a psychotherapist, it is up to you whether you start billing via OKP later in 2022. It is also possible to "drive in parallel": some patients are already in treatment via OKP, other patients are still in the delegation model. It is important to inform people that psychological psychotherapy is now an OKP service.

Answer: Yes, if the psychological psychotherapist and the psychiatrist, for example, share the same office, this is permitted. A good cooperation is definitely in the interest of the patients. In other words, the psychological psychotherapist may request a case evaluation after the 30th session.

Whether such a close cooperation is also accepted if the doctor is a partner in a joint-stock company and runs the organization of psychological psychotherapy is not entirely clear. It is important that no dependencies arise from an economic point of view.

Even if a general practitioner has made the order and the psychiatrist is in the same practice location as the psychological psychotherapist, he/she may also make the case assessment.

Answer: The rule is to divide by the number of persons present. There must be a valid order for each person. The divisor rule does not apply to family therapy.

Answer: If psychotherapy is to be continued after 30 sessions for services under paragraph 1 letter a, the procedure under Article 3b applies mutatis mutandis. The report with the proposal for continuation is made by the ordering physician. It shall contain a case assessment carried out by a specialist with a postgraduate qualification in psychiatry and psychotherapy or in child and adolescent psychiatry and psychotherapy.

Answer: Whether a patient has to be seen for the psychiatric case assessment or the (child) psychiatrist, based on the report that has to be prepared for the application for cost coverage (written by the treating psychotherapist), is decided by the person who carries out the case assessment, namely the psychiatrist. If the report does not provide sufficient information, further information can also be requested from the ordering physician.

Answer: No, the electronic patient dossier (ePD) has nothing to do with the introduction of the prescription model as of 1.7.22. However, since the commission motion 19.3955 was accepted, the ePD has also become mandatory for all service providers in the outpatient area.

Yes, the consent to the IV contract also applies to military and accident insurance. If you would like to pay for these insurances, you must complete the consent form and send it to the secretariat at info@sbap.ch. This will be sent to the FSIO at the end of each month and is valid for the following month.

Answer: Tiers garants: the invoice data is sent in xml format to a data exchange platform (e.g. Medidata, Medidoc) via the service provider's software and the invoice is sent to the patient. The patient pays the invoice and reclaims a contribution (minus statutory cost sharing) from the insurer via a reclaim document.

Tiers payants: via the service provider's software, the invoice data is forwarded directly to the insurer in xml format. The insurers pay the invoice and claim the deductible from the insured person. Since 1.1.2022, the service provider is legally obliged to send the patient a copy of the invoice.

Answer: Yes, this must also be declared to the canton. A start date is also required on the application for a ZSR number.

Answer: Nothing changes for contract members (who have already joined the IV/UV/MV contract via SBAP); they can continue to charge the "rate of CHF 154.80/hour" to the UV/MV/IV insurers.

The billing of services provided by a psychotherapist in the hospital/clinic will continue to be carried out in accordance with TARMED (TARMED chapter 02.02) and is still possible until December 31, 2024.

Answer: Both basic insurers Assura and Atupri do not accept the tier payant model. In this case, the client pays the entire bill first and then claims the cost sharing from the health insurance company via a reclaim voucher.

Answer: First, consult the tariff browser and read the interpretation behind the position. The handbook in the members area will help as well. If you still have questions, please contact the SBAP Professional Policy Manager.

Answer: Two closely related persons are considered to be a family (even just one parent and one child, for example). In this case, only the index patient is billed. If the index patient does not participate, the session can be billed as coordination with third persons.

Answer: With the introduction of the prescription model, a psychological condition with disease value became a compulsory OKP benefit. This means that, according to the subsidiarity principle, the supplementary insurances are no longer the primary service providers. Therefore, in many cases, they refuse to cover the costs. Nevertheless, it is worthwhile to clarify in advance what applies in the individual case.

Note on SWICA: Under certain circumstances, SWICA will cover the costs of psychotherapy services provided by psychotherapists under the COMPLETA TOP and OPTIMA supplementary insurance plans. In order to be billed via the supplementary insurances, you must, among other things, be recognized as a SWICA psychotherapist. > Info page SWICA

Answer: In the implementation of the KVG amendment, the term "approval of service providers" is used: In principle, only services provided by approved service providers are reimbursed by the OKP. A hospital, an outpatient care facility or an organization of non-physician service providers may also bill the OKP if it employs specialists in further training - provided, however, that the majority of the specialists working there meet the admission requirements and ensure supervision of the activities of the person in further training. Therefore, if a service in the hospital, in an outpatient care facility or in an organization of non-physician service providers is provided by a person in continuing education, the hospital, the facility or the organization has supervisory duties as an approved service provider (supervision by a specialist who fulfills the OKP admission requirements) and must ensure that the services provided are effective, expedient and economical (WZW criteria). The hospital or the institution or organization approved as an OKP service provider is responsible for this and bills the OKP.

Answer: The tax point value of CHF 2.58 per minute has been approved in all cantons. Please keep a copy of your invoices in case of subsequent billing.

The effects of the amendment to the SIWF for the recognition of training centers with regard to the regulation in Article 50c KVV concerning clinical experience are presented below.

As, according to the SIWF, this is an editorial adjustment to the categories of training centers, an activity at a training center that will only be recognized within the framework of a specialty (geriatric psychiatry and psychotherapy) from January 1, 2024 onwards will not be recognized. Since, according to the SIWF, this is an editorial adjustment to the categories of training institutions, an activity at a training institution which, from 1 January 2024, only has recognition in the context of a specialty(geriatric psychiatry and psychotherapy, consultation and liaison psychiatry, forensic psychiatry and psychotherapy, psychiatry and psychotherapy of addictive disorders; categories A or B), but no recognition as category C according to the adjusted training programme for psychiatry and psychotherapy, will continue to be recognized as an activity in accordance with Article 50c letter b number 1 KVV.

The FOPH is working on an editorial amendment to the KVV that reflects the changes in the SIWF recognitions of the training institutes and basically enables a seamless transition in the recognition of the clinical experience acquired there for admission to the OKP.

For those working in child and adolescent psychotherapy in the future, there will be no change to the applicable requirements under Article 50c letter b number 2 KVV, as no changes will be made to the "Specialist in child and adolescent psychiatry" training program with regard to the categories of training centres.

You can find the entire letter here.

Answer: No, you can pay VAT voluntarily, but you don't have to. See here.

Answer: No, if you have more than three years of full-time equivalent clinical work experience, you will not be required to complete the third clinical year.

The transitional rule states that individuals who have not completed a third clinical year at the time of enactment must be able to demonstrate at least three years of professional practice experience (full-time equivalent) in psychotherapeutic-psychiatric care under assurance of professionally qualified supervision. This practical experience can take place independently in one's own professional responsibility or delegated (inpatient as well as outpatient).

Answer: The delegated psychotherapists are requested to find a solution with their delegating psychiatrists/supervisors regarding practice premises, etc. The insurance will no longer pay for services in the delegated system after a transitional period of six months. After a transitional period of six months, the insurance will no longer pay for the services in the delegated system.

Answer: The cantons are responsible for the approval. No, the approval will only be valid for one canton.

Answer: This number has to be applied for at SASIS AG after the authorization by the canton in which the psychological psychotherapy is offered. As an employee of an organization of psychological psychotherapy, a K number is applied for. The entire organization applies for its own ZSR number. Regarding the approval by the cantons, an important information: The cantons are different in the design of their approval processes, please inform yourself at the respective canton in which the psychotherapy practice is operated.

Answer: This can be seen in the PsyReg.

Answer: Yes, this makes sense, because a valid professional license must be available in order for the cantons to review the requirements for licensing. The cantons are at different stages of the licensing process (in the canton of SO, applications can already be submitted; in the canton of ZH, the deadline is not until the beginning of March 2023).

Answer: Yes, it is necessary to purchase software that has an xml interface. This is required for the transmission of electronic invoices to a TrustCenter or to external service providers such as MediPort (data exchange platform). The Ärztekasse still offers a service where service sheets filled out by hand are entered electronically - but you pay accordingly for this.

Answer: There is a possibility for previously insured persons to apply for continued coverage. Depending on the insurance, this applies for the first 30-90 days after termination. Check with your employer's current daily sickness benefits insurance for your options. In some cases, acceptance into an individual insurance plan is possible without a health check.

Answer: Effectively, applications for OKP approval can also be submitted after July 1, 2022. This will also be possible via transitional provisions (however, the deadline by which the conditions had to be met is 1.7.22). Please check with the canton in which your practice is located. For the cantons of AG, SO and ZH, the facts described above apply.