How to use it
Look for evidence across the complete transaction.
For every unchecked item, identify the system of record, control owner, review frequency and the report or transaction evidence used to verify it.
Billing and procedures
- Every clinical procedure creates or matches a billable line item.
- Ward and OT consumables are attributed to a patient encounter.
- Diagnostic tests performed reconcile to orders and charges.
- Tariff changes and manual charge edits have an audit trail.
- Final IPD bills include all charges accumulated before discharge.
Pharmacy and inventory
- Every dispense matches a prescription or approved clinical order.
- Dispensed quantities reconcile to patient invoice quantities.
- Cancellations and returns reverse the related stock movement.
- Stock adjustments include a reason, owner and approval record.
- Expiry, stock-out and overstock risk is reviewed from actual consumption.
Cancellations, discounts and refunds
- Late cancellations are checked against fulfilment status.
- High-value cancellations require documented approval.
- Discounts outside policy are flagged and reviewed.
- Refunds match the original payment and service outcome.
- Repeated exceptions by user, department or reason are monitored.
Claims and discharge
- Clinical documentation supports every material claim charge.
- Claim deductions and short payments are categorised and analysed.
- Missing claim documents are identified before submission.
- Pending orders and results are resolved before discharge closure.
- Outstanding patient and insurer balances remain linked to the encounter.
Payment and reconciliation
- Cash, digital and insurer payments reconcile to valid bills.
- Cancelled bills remain traceable to their original transaction.
- Billing, pharmacy and inventory exceptions are reviewed together.
- Each exception has an accountable owner and resolution status.
- Recovered leakage and process fixes are measured over time.
What the checklist can—and cannot—tell you
It identifies control gaps worth investigating. It does not calculate or guarantee a loss. Use the revenue-at-risk calculator for a directional estimate, then validate against real records.
From checklist to evidence
Want us to identify these patterns in your hospital?
Review billing, pharmacy, inventory and payment workflows with the Shucon team.