Intensity must be visible
ICU tariffs price continuous monitoring and intervention-readiness. A chart with four-hourly entries invoices a ward stay at ICU rates — and the payer’s reviewer knows it. The record must look like the intensity it charges.
Step-down timing is money in both directions
Keeping a stable patient in ICU burns a scarce bed and invites deduction; premature step-down risks the patient and a readmission. A documented daily fitness-for-step-down decision protects both.
| Item | Standard | Consequence / owner |
|---|---|---|
| Monitoring frequency | Matches ICU claim intensity | Hourly entries, signed |
| Daily justification | Why ICU today, documented | Intensivist note |
| Step-down decision | Daily, recorded either way | Rounds |
| Consumable usage | Charted at use | Nurse record |
| Ventilator hours | Log matches bill | Respiratory chart |
Consumables ride on the chart
High-value ICU consumables get paid when the chart shows their use — the infusion recorded, the line change noted. Items billed without chart shadows are the first lines deducted.
What to do on Monday
- Audit five ICU files: does chart frequency match billed intensity?
- Add the daily step-down line to ICU rounds notes.
- Pick your five costliest consumables; verify chart shadows.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.