Charge and evidence review

A charge line belongs to a hospital service episode. It can record sequence, description, quantity, unit, observed date, service date, amount, charge code, approved fee, payroll reference and an outcome of pending, accepted or rejected. The parent episode gives the item its employee, department definition, organization and operational owner. A reviewer can inspect a questionable charge in that context instead of looking at an isolated amount.

Evidence documents also belong to the episode and can carry an attachment, external reference, document date and verification flag with the person who checked them. A review decision records the episode revision, reviewer, decision, date, reason and evidence reference. This separates the act of collecting support from the act of deciding whether the episode can proceed. The team can record subsequent status changes in state history with an actor and operation key.

• Charge detail. Each line identifies the parent episode and the item being assessed.
• Supporting evidence. Documents and verification records keep the review tied to a dated source.
• Decision and remediation. The reviewer records a decision; follow-up actions name the assignee, due date and resolution.

Decide how a charge code and approved fee are supplied and who checks them. Agree when an item can be marked accepted or rejected, and how a rejected line is corrected. Name the people who can verify evidence and the people who can record an independent review decision. A reviewer should identify the revision being assessed; if the episode changes after that decision, the team needs another review of the changed work.

Assign follow-up actions to named people and set a due date when a document or amount needs attention. The action’s completion status and resolution text should answer what changed. Decide whether an unresolved action blocks closure and have the owner check that condition before setting the final episode status.

Take an episode with a charge that differs from the approved fee. In the charge review list, inspect the amount, quantity, code and source reference. Attach the dated supporting document and ask the verifier to record the check. The Service Reviewer opens the current episode revision and records a decision with a reason and evidence reference. If the charge is returned for correction, the Hospital Operations Owner assigns follow-up. Once the assignee records a resolution, the owner and reviewer inspect the corrected line and its evidence. The Finance Reviewer can then compare the expected value with the confirmed external amount.

• Charge line review — Pending or rejected items with parent episode, amount and code.
• Review decisions pending — Episode revisions awaiting a recorded decision.
• Open follow-up — Outstanding actions with assignee, due date and status.

See service review and value reconciliation.