In this guide 6 sections
Most of it leaks where one record is copied into another: chart to bill, indent to stock, discharge file to TPA claim. Charging items as they are recorded closes the first gap. GullySystem’s Hospital/Clinic Management System keeps these on one patient record. A hundred-bed hospital needs a fuller information system.
Ward charges that stay on the treatment chart
Nurses note injections, consumables and procedures on the treatment chart through the stay. At discharge, a clerk reads the chart and copies charges into the bill. Anything given at night, or written in a hurry, can be missed.
The fix is to charge an item when it is recorded, not at discharge. The bill then grows through the stay. The clerk checks it instead of building it.
- Injections and drips given outside OPD hours
- Consumables used in procedures
- Extra doctor visits on the ward
- Room changes during the stay
Pharmacy issues that never reach a patient
The pharmacy issues strips against a ward indent. If the indent is not tied to a patient, the issue leaves stock but lands on no bill. Compare a week of pharmacy issues against medicines billed. The difference is worth a look.
Expiry is the other leak. Ordering by eye lets a slow strip expire while a common antibiotic runs out. Reorder levels and an expiry list read each month deal with both.
TPA claims that come back as queries
A cashless claim needs the pre-authorisation, the discharge summary, bills and reports. A missing report or an unsigned summary brings it back as a query. Each query delays payment. Some are never answered.
Keep the claim status against each bill: raised, queried, pending or settled. The desk can then see which insurer holds which file. A weekly list of old queries gives someone a clear job.
What an insurer pays depends on the policy and the TPA’s terms. Your billing head or claims adviser should read those terms.
- Pre-authorisation reference on the admission
- Discharge summary signed before the file goes
- Reports attached from the patient record
- Query date and reply date logged
Beds that look full when they are not
Casualty calls the ward to ask whether a room is free. The ward says a discharge is coming. The family waits, and sometimes leaves.
A bed board showing occupied, discharging and free rooms answers that question at the desk, without a call to the ward sister or a walk upstairs. Average length of stay by consultant, read monthly, shows where discharges run late. Ask whether a late discharge is clinical or a billing delay.
How to find your own leaks this month
Pick ten recent discharges. For each, lay the treatment chart, pharmacy issues and final bill side by side. Mark every chart item missing from the bill.
Then list every open TPA claim with its age and status. Count the medicines written off as expired last quarter. These three counts show which gap to close first. A small nursing home may find one change at discharge is enough.
Discharge leak check
Each discharge gets a row, with columns for chart items, pharmacy issues, items billed and items missing. A second tab lists open TPA claims by age and insurer. Fill it for ten discharges before deciding what to change.
Open a blank worksheet to printQuestions owners ask
Does it cover IPD as well as OPD?
Yes. Admission, bed allotment, ward charges and discharge sit on the same patient record as OPD visits. An admitted patient is not registered again.
Can lab test orders and results be tracked in it?
No. There is no pathology laboratory module, so sample status and result entry stay in your lab system. Finished reports can be added to the patient record.
Will software make our nursing home NABH accredited?
No. Software can keep the case notes, bills, stock and access logs an assessor may ask to see. Accreditation stays between your hospital and the assessing body.
Is it suitable for a hundred-bed hospital?
Probably not as the main system. It suits clinics, nursing homes and small hospitals. A larger hospital is better served by an established hospital information system.