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Dialysis: recurring claims need an assembly line

A dialysis patient files the same claim forty times a year. Design the file once; run it forever.

BLOG · PAYER MECHANICS
● Format mechanism table
● Invented stats 0
● Figures worked arithmetic
✓ no figure without its working

Standing documents, standing file

Nephrology plan, vascular-access notes, standing prescription — assemble the annexure once, update on change, attach always. Rebuilding the justification per session is how sessions get queried at random.

Session-level truth

Each sitting needs its own timestamps, machine log, and consumable record. Batch-filed months with copy-pasted session notes are the pattern payers’ fraud screens are literally built to catch — honest units get flagged for lazy paperwork.

The dialysis file: built once, run weekly
ItemStandardConsequence / owner
Standing annexurePlan, access, prescriptionUpdate on change only
Per-session recordTime in/out, machine, consumablesEvery sitting
Authorisation blockSessions remaining trackedRenew at threshold
Monthly statementSessions vs authorisations reconciledBilling
Transport / EPO extrasScheme-specific coverage checkedDesk

Scheme cycles differ

Government schemes authorise dialysis in blocks with renewal gates. Track the block, renew before exhaustion, and the patient never faces a session the system won’t cover.

What to do on Monday

Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.

Read the mechanism. Now check your own numbers.

Bring twenty settled claims, advices only, patient details redacted. We name the clause behind each reduction and you keep the findings.