The list is the law
Day-care coverage attaches to the payer’s enumerated list, not to your clinical judgement about what needs a bed. A procedure outside the list, done as day-care, may need the 24-hour admission it medically didn’t require — or a different filing strategy discussed with the payer beforehand.
Duration documentation cuts both ways
File a listed day-care procedure with notes reading like an inpatient stay and the payer queries the mismatch. File it with no timeline at all and the payer queries the existence. Admission time, procedure time, discharge time — three timestamps end the argument.
| Item | Standard | Consequence / owner |
|---|---|---|
| Procedure on payer list | Verify before scheduling | Insurance desk |
| Three timestamps | Admit, procedure, discharge recorded | OT / ward nurse |
| Day-care tariff applied | Not the inpatient template | Billing |
| Observation beyond plan | Convert with intimation, documented indication | Treating team + desk |
| Discharge summary | States day-care explicitly | Treating doctor |
Packages behave differently in day-care
Room components, pre-op investigations, and post-op observation are bundled differently for day-care tariffs. Billing the inpatient template against a day-care authorisation is the quiet source of a steady deduction trickle.
What to do on Monday
- Print the day-care lists of your top three payers for the OT desk.
- Add the three timestamps to the day-care template.
- Separate day-care and inpatient billing templates in your system.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.