AYUSH inpatient compliance

Check an AYUSH inpatient admission against the facility criteria, the minimum stay and the records, then settle each bill line by category on a sample case.

The question it answers

Does this AYUSH admission meet the conditions, and what is payable?

You give it: The facility, the dates and times of stay, what is recorded in the file, and the bill lines with your classification.

You get: A recommendation, each criterion with met or not met, the lines deducted and why.

The idea

An AYUSH admission is tested in a fixed order: the facility, the stay, the records, then each line of the bill.

Rules that run, in order

1. Facility criteria: beds, staffing, therapy section, records
2. A stay of at least 24 hours unless a day-care procedure
3. Records: condition, treatment plan, daily charts, monitoring
4. Wellness and diet items are not payable
5. A therapy not linked to the diagnosis is deducted

How well the rules are sourced

AYUSH cover at par with other treatment is read in the Master Circular (Official text). The facility criteria and the minimum stay come from secondary summaries (Secondary). The line classifications and the order of priority are Draft.

What it does not do

It gives a recommendation for the reviewer, never a decision. The classification of each line is the reviewer’s to choose.

Steps

1. Describe the facility. The system of medicine, the type of facility, the number of inpatient beds, round-the-clock cover, qualification, therapy section and records.
2. The facility is tested. A government or teaching AYUSH hospital passes on type. A standalone hospital must also meet the criteria for beds, staffing, therapy section and records.
3. The stay is tested. The admission must reach the policy minimum, 24 hours unless the policy says otherwise. A listed day-care procedure is exempt.
4. The records are checked. Acute or active condition, a treatment plan, daily charts and continuous monitoring. Anything missing is listed and the recommendation becomes a query.
5. Each bill line is classified. You choose the category. Wellness, rejuvenation and diet items are not payable, and a therapy you do not link to the diagnosis is deducted. A line with no category is returned, not guessed.
6. Recommendation, never a decision. The result follows a fixed order of priority and is always a recommendation for the reviewer. Download the checklist as a PDF.

Every case on this site is synthetic. These are working drafts and illustrations, not a claim decision or legal advice. The interactive worksheets need JavaScript; nothing is sent anywhere.