In Swiss outpatient care, reimbursement does not follow what you did — it follows what you documented, and into which category you documented it. The **KLV** (Krankenpflege-Leistungsverordnung) defines the categories of nursing services that mandatory health insurance contributes to, and every care act a Spitex team performs must be attributed to the right one. Under KLV Art. 7, these three categories are: (a) assessment, advice, and coordination; (b) examination and treatment; and (c) basic care. Here are the three categories, what belongs in each, and the documentation habits that keep reimbursement correct.
1. Assessment, Advice, and Coordination
The first category covers clarifying care needs, advising patients and their families, and coordinating with physicians, therapists, and other services. It is the category most often under-documented, because much of this work does not look like hands-on care: the phone call with the family doctor, the medication review with a relative, the reassessment after a hospital discharge. Teams that treat these acts as informal extras leave systematically reimbursable work unrecorded. The documentation habit that matters here is capturing coordination touchpoints as they happen — ideally by voice, in the moment — so they enter the ledger with a timestamp and a purpose.
2. Examinations and Treatment Care
The second category comprises medically delegated examination and treatment services: wound care, injections, medication management, vital-sign monitoring, and comparable clinical interventions. These acts are usually well captured — they are visible, scheduled, and tied to a physician's order. The risk here is not omission but drift: a treatment intervention recorded without reference to the underlying prescription, or a duration estimated generously after the fact. Correct practice ties each treatment act to the current physician order and records real durations at the point of care, because the insurer contribution differs by category and auditors compare recorded care against prescriptions. Under KLV Art. 7a, mandatory health insurance contributes CHF 76.90 per hour for assessment and advice, CHF 63.00 per hour for treatment care, and CHF 52.60 per hour for basic care.
3. Basic Care
The third category covers support with daily living activities that have a nursing character — personal hygiene, mobilization, dressing, eating support. Basic care typically makes up the largest share of recorded hours in home care, which makes its documentation quality decisive for the overall billing picture. Two failure modes dominate: bundling distinct acts into one undifferentiated block, and categorizing household-type support (which is not KLV-reimbursable) as basic care. Clean documentation separates the nursing-character acts from non-KLV services at the source, so the reimbursable and non-reimbursable shares never blur.
Why Structure Beats Memory
Across all three categories, the common thread is the same: categorization decisions made days after the visit are reconstructions, and reconstructions favor whatever is easiest to write down. A documentation system that offers the right category at the moment of care — pre-structured around the KLV framework, with the care plan and physician orders in view — turns correct attribution into the path of least resistance. Ambient voice capture strengthens this further: the caregiver describes the visit naturally, and the structured record sorts the acts into their categories for confirmation rather than manual entry.
The KLV categories are the grammar of Spitex reimbursement. Teams that internalize them — and document within them from the first minute of the visit — spend less time defending claims and more time delivering the care those claims describe.
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