HMS – Billing & RCM

Dashboard Overview

Real-time snapshot of Billing & Revenue Cycle Management

Total Revenue (MTD)

₹1.84 Cr

▲ 8.2% vs last month

Bills Generated

4,218

▲ 312 this week

Collection Rate

87.4%

▲ 2.1%

Pending Claims

₹42.6 L

▼ 3 claims aging >60d

Revenue by Category

OP Billing

72%

IP Billing

55%

Credit Billing

38%

Pharmacy

26%

Quick Stats

Avg Bill Value

₹4,362

Discharge Pending

23

Claims Submitted

186

Denials MTD

12

Recent Activity

Bill #BL-24801 Finalized
10 min ago
IP Patient – Ravi Kumar | ₹38,450
Claim #CL-5512 Pending Review
34 min ago
Star Health | ₹1,12,000
Settlement Received
2 hr ago
New India Assurance | ₹2,45,000

Pending Discharge

Patient	Ward	Days	Status
Arjun Reddy	General	4	Pending
Meena Devi	ICU	7	Critical
Suresh P.	Semi-PVT	2	Review

Credit Claims Pipeline

Submitted

186

Under Review

84

Approved

115

Denied

12

Top Denial Reasons

CO-4Service not covered4

PR-1Deductible not met3

CO-29Duplicate claim3

OA-1Auth not obtained2

Outpatient (OP) Billing

Manage outpatient service charges with the same IP billing experience.

Today's OP Bills

218

▲ 14 vs yesterday

OP Revenue (Today)

₹3.2 L

Paid Bills

194

▲ 89%

Pending Payments

24

Patient Lookup

OPD Number

Patient Name

Search by OPD number or patient name to load OP details, service history and payment summary.

OP Billing Summary

Consultation₹ 0

Procedures₹ 0

Lab & Diagnostics₹ 0

Pharmacy₹ 0

Total OP Due₹ 0

Consultation

Procedure

Lab / Diagnostics

Pharmacy

Consultation Charges

OPD No	Patient	Type of Service Charges	Doctor	Consultation Type	Status
OPD-3001	Sonia Mehta	Consultation	Dr. Rao	Follow-up	Paid
OPD-3002	Arjun Patel	Consultation	Dr. Sharma	New Visit	Pending
OPD-3003	Meera Reddy	Consultation	Dr. Nair	Teleconsult	Paid

Add Consultation Charge

OPD Number

Type of Service Charges

Doctor

Consultation Type

Amount (₹)

Status

OPD No	Patient	Type of Service Charges	Procedure	Doctor	Status
OPD-3004	Kavya Singh	Minor Procedure	Wound Dressing	Dr. Kumar	Paid
OPD-3005	Harish Rao	Minor Procedure	Joint Injection	Dr. Mehta	Pending
OPD-3006	Priyanka Iyengar	Minor Procedure	Gastroscopy	Dr. Sharma	Scheduled

Order No	OPD No	Patient	Type of Service Charges	Test	Lab	Date	Status
LAB-9101	OPD-3007	Rajesh T.	Pathology	CBC + Sugar	Central Lab	21/05/26	Done
LAB-9102	OPD-3008	Nisha Patel	Radiology	Chest X-Ray	Radiology	22/05/26	Pending
LAB-9103	OPD-3009	Vijay Sharma	Pathology	Urine RE	Central Lab	22/05/26	Done

Rx No	OPD No	Patient	Type of Service Charges	Items	Date	Status
RX-3301	OPD-3010	Priya M.	Medicine	Amoxicillin, Paracetamol	21/05/26	Dispensed
RX-3302	OPD-3011	Rahul Mehra	Consumable	Urine Bag, Syringe	22/05/26	Dispensed
RX-3303	OPD-3012	Leena Das	Medicine	Insulin, Glucose Strip	22/05/26	Partial

Inpatient (IP) Billing

Manage all inpatient charges across departments

Active Admissions

142

IP Revenue (MTD)

₹84.2 L

Avg LOS

4.7d

Unbilled Charges

₹6.8 L

Patient Retrieval

Patient ID / Admission ID

UHID Number

Enter a Patient ID, Admission ID, or UHID to load inpatient details and charge history before posting service billing entries.

Billing Usage & Quantity Summary

Room & Stay₹ 0

Doctor Consultation₹ 0

Lab & Diagnostics₹ 0

Pharmacy₹ 0

Surgery & Procedures₹ 0

Miscellaneous₹ 0

Total Gross₹ 0

Room & Stay

Doctor Consultation

Lab & Diagnostics

Pharmacy & Medicines

Surgery & Procedures

Miscellaneous

Room & Stay Charges

IPD No	Patient	Type of Service Charges	Room Type	Days	Rate/Day	Total	Status
IPD-1001	Ravi Kumar	Room Stay	General Ward	5	₹800	₹4,000	Billed
IPD-1002	Sunitha Devi	Room Stay	Semi-Private	3	₹1,500	₹4,500	Pending
IPD-1003	Naresh Babu	Critical Care	ICU	2	₹5,000	₹10,000	Active
IPD-1004	Latha Reddy	Room Stay	Private	4	₹3,200	₹12,800	Billed

Add Room Charge

IPD Number

Type of Service Charges

Room Type

From Date

To Date

Notes

IPD No	Patient	Type of Service Charges	Doctor	Specialty	Visits	Rate	Total	Status
IPD-1001	Ravi Kumar	Consultation	Dr. Mehta	Cardiology	3	₹600	₹1,800	Billed
IPD-1002	Sunitha Devi	Consultation	Dr. Sharma	Neurology	2	₹800	₹1,600	Pending
IPD-1003	Naresh Babu	Consultation	Dr. Rao	Pulmonology	5	₹500	₹2,500	Active

Order No	IPD No	Patient	Type of Service Charges	Test	Lab	Amount	Date	Status
LAB-8801	IPD-1001	Ravi Kumar	Pathology	CBC + LFT Panel	Central Lab	₹1,200	12/05/25	Done
LAB-8802	IPD-1003	Naresh Babu	Radiology	CT Chest	Radiology	₹4,500	13/05/25	Pending
LAB-8803	IPD-1002	Sunitha Devi	Radiology	MRI Brain	Radiology	₹8,000	13/05/25	Processing

Rx No	IPD No	Patient	Type of Service Charges	Items	Amount	Date	Status
RX-2201	IPD-1001	Ravi Kumar	Medicine	Metoprolol, Aspirin (3 days)	₹480	10/05/25	Dispensed
RX-2202	IPD-1002	Sunitha Devi	Medicine	IV Antibiotics, Saline	₹1,240	11/05/25	Dispensed
RX-2203	IPD-1003	Naresh Babu	Consumables	Bronchodilator, Steroids	₹920	12/05/25	Partial

Proc No	IPD No	Patient	Type of Service Charges	Procedure	Surgeon	OT	Amount	Status
PR-4401	IPD-1004	Latha Reddy	Surgery	Appendectomy	Dr. Rajan	OT-2	₹45,000	Done
PR-4402	IPD-1001	Ravi Kumar	Surgery	Angioplasty	Dr. Mehta	Cath Lab	₹1,20,000	Scheduled

Ref	IPD No	Patient	Type of Service Charges	Description	Amount	Date
MC-001	IPD-1001	Ravi Kumar	Transport	Ambulance Service	₹1,500	10/05/25
MC-002	IPD-1002	Sunitha Devi	Accommodation	Attendant Bed Charge	₹300	11/05/25
MC-003	IPD-1003	Naresh Babu	Consumables	Oxygen Surcharge	₹840	12/05/25

Final Billing

Consolidate, review and finalise patient bills before discharge

General Billing

Credit Billing

Bills Pending Finalization

38

Finalised Today

22

Total Collected

₹18.4 L

Dues Outstanding

₹3.2 L

Bills for Finalization

Bill No	Patient	Adm. Date	Dis. Date	Gross Amt	Concession	Net Amt
BL-24880	Ravi Kumar	08/05	13/05	₹62,400	₹2,000	₹60,400
BL-24881	Priya Nair	09/05	13/05	₹28,900	₹0	₹28,900
BL-24882	Mohan Reddy	07/05	14/05	₹1,42,000	₹5,000	₹1,37,000

Bill Preview – BL-24880

Ravi Kumar

IPD-1001 | DOA: 08/05/25

Cardiology

Room & Stay (5d)

General Ward

₹4,000

Doctor Visits (3)

Dr. Mehta

₹1,800

Lab Tests

CBC, LFT, ECG

₹2,800

Pharmacy

5-day course

₹480

Procedures

Angioplasty

₹1,20,000

Misc Charges

Ambulance, Oxygen

₹2,340

Gross Total₹1,31,420

Insurance Credit-₹80,000

Concession-₹2,000

Patient Due₹49,420

Claim ID	Bill No	Patient	Payer	Type	Submitted	Amount	Status
CL-5500	BL-24860	Kavya Singh	Star Health	TPA	10/05/25	₹85,000	Under Review
CL-5501	BL-24862	Harish Rao	CGHS	Govt	09/05/25	₹42,000	Approved
CL-5502	BL-24864	Priya M.	New India	Insurance	08/05/25	₹1,25,000	Denied
CL-5503	BL-24866	Naresh T.	Aarogyasri / Ayushman Bharat – PMJAY	State Scheme	07/05/25	₹32,000	Pending Docs

Field	Details
Scheme Name
Beneficiary Status	Active
Total Coverage	₹5,00,000
Used Amount	₹0
Available Balance	₹5,00,000
Family Members Covered	4
Empanelled Hospital	HMS Hospital , Hyderabad ✅
Eligible Procedures	CABG, Valve Replacement, Angioplasty
Scheme Validity	31 Mar 2025

Claim No	Patient	Scheme	Package	Package Amt	Submitted	Status
GC-1101	Ramu Yadav	Aarogyasri / Ayushman Bharat – PMJAY	Coronary Angioplasty	₹1,20,000	08/05/25	Approved
GC-1102	Sunitha B.	CGHS	Hysterectomy	₹60,000	09/05/25	Under Review
GC-1103	Mohan Lal	Aarogyasri / Ayushman Bharat – PMJAY	Knee Replacement	₹80,000	07/05/25	Pending Docs
GC-1104	Deepa Rani	EHS	Normal Delivery	₹15,000	06/05/25	Approved

Payer	Claims	0-30d	31-60d	>60d	Total AR
Star Health	48	₹8.4 L	₹4.2 L	₹2.1 L	₹14.7 L
CGHS	32	₹6.2 L	₹3.8 L	₹1.4 L	₹11.4 L
Aarogyasri / Ayushman Bharat – PMJAY	42	₹5.1 L	₹2.8 L	₹1.6 L	₹9.5 L
New India	24	₹2.3 L	₹1.6 L	₹3.1 L	₹7.0 L

Settlement No	Claim ID	Patient	Payer	Claimed	Settled	Deduction	Date	Status
SET-8801	CL-5490	Arjun Reddy	Star Health	₹1,20,000	₹1,12,000	₹8,000	12/05/25	Full
SET-8802	CL-5492	Meena L.	CGHS	₹50,000	₹48,200	₹1,800	11/05/25	Full
SET-8803	CL-5498	Venkat Rao	New India	₹3,00,000	₹2,45,000	₹55,000	10/05/25	Partial
SET-8804	GC-1101	Ramu Yadav	Aarogyasri / Ayushman Bharat – PMJAY	₹1,20,000	₹1,20,000	₹0	09/05/25	Full

Bill Generation

Review the live bill summary, switch to Final Billing to edit the General and Credit inputs, and generate the receipt once ready.

Bill Status Workflow

✓

Draft

Bill prepared

✓

Verified

Charges checked

3

Approved

Ready for payment

4

Finalized

Receipt issued

● Awaiting Final Generation No bill generated yet

Final Billing

Bill Review

Generated Bill Summary

No bill has been generated yet. Use Final Billing to create the receipt.

Patient

Ravi Kumar

Bill Reference

Pending

Patient Type

IP

Payment Mode

Not selected

Billing SourceGeneral + Credit Billing

Advance Payment₹ 20,000

Insurance Claiming₹ 80,000

Government Scheme Claiming₹ 0

Discounts / Concessions₹ 2,000

Total Amount₹ 2,11,420

Remaining / Payable₹ 1,09,420

Cashless StatusAuto-marked / Pending

Payment Confirmation

Payment will be confirmed after the Final Billing screen is used to generate the bill.

Discharge Summary Automation

IP discharge summary is pending until the final bill is generated.

Revenue Analytics

Track and analyse revenue performance across all billing streams

Revenue YTD

₹8.42 Cr

▲ 12.4% YoY

ARPU (Avg Revenue/Patient)

₹4,362

Net Collection Rate

87.4%

Bad Debt Rate

2.1%

▼ 0.3%

Monthly Revenue Trend

Revenue by Department

Top Departments

Cardiology

88%

Orthopedics

72%

Oncology

64%

Neurology

55%

Payer Mix Analysis

CASHSelf Pay₹3.2 Cr

INSInsurance₹2.8 Cr

GOV₹1.8 Cr

TPATPA₹0.62 Cr

Collection Efficiency

Billed₹9.63 Cr

Collected₹8.42 Cr

Uncollected₹1.21 Cr

Refunds & Adjustments

Review refund requests, adjustment queues, and deposit reversals in one consolidated module.

Pending Approvals

12

▼ 2 from last week

Processed MTD

₹18.4 L

▲ 11% this month

Rejected

7

▼ 1 from yesterday

Advance Deposits Refunded

₹4.8 L

▲ 6% vs last month

Pending Approvals

Processed / Completed

Advance Deposits

Rejected / Cancelled

Refund Requests Awaiting Approval

Manager Approval Pending

Req ID	Date	Patient	Ref Bill/Rec	Reason	Requested By	Amount
RFD-2041	16/05/25	Rakesh Menon	IPD-1008 / REC-118	Duplicate charge on pharmacy	Nurse Priya	₹2,450
RFD-2045	17/05/25	Divya Sinha	OPD-2211 / REC-121	Consultation fee correction	Billing Desk	₹1,180
RFD-2051	18/05/25	Imran Khan	IPD-1022 / REC-129	Ownership transfer adjustment	Finance Exec	₹5,640

Req ID	Approved Date	Patient	Ref Bill/Rec	Mode	Approved By	Amount	Status
RFD-2018	12/05/25	Shreya Iyer	IPD-0996 / REC-104	UPI Reversal	Manager Anita	₹3,200	Settled
RFD-2024	13/05/25	Nitin Verma	OPD-2105 / REC-107	Card Chargeback	Manager Sandeep	₹860	Settled
RFD-2030	15/05/25	Farha Patel	IPD-1002 / REC-113	UPI Reversal	Manager Asha	₹4,120	Settled

IPD No	Patient	Discharge Date	Total Deposit	Final Bill	Refund Due
IPD-1004	Latha Reddy	13/05/25	₹18,500	₹49,420	₹2,900
IPD-1006	Rohit Kapoor	10/05/25	₹12,000	₹42,100	₹1,650
IPD-1011	Geeta Rao	14/05/25	₹10,250	₹31,800	₹1,120

Req ID	Date	Patient	Ref Bill/Rec	Amount	Rejected By	Reason for Rejection
RFD-1998	09/05/25	Arti Joshi	IPD-0988 / REC-92	₹1,240	Manager Deepa	Insufficient supporting document
RFD-2008	11/05/25	Manoj Sahu	OPD-2083 / REC-96	₹760	Manager Rahul	Request cancelled by patient
RFD-2013	12/05/25	Varun Malhotra	IPD-0994 / REC-99	₹2,050	Manager Priya	Refund amount exceeds allowable adjustment

Denial Management

Track, appeal, and resolve claim denials

Total Denials (MTD)

12

▼ 2 vs last month

Denial Value

₹8.4 L

Appeals Won

7

▲ 58% success

Pending Appeal

3

Denied Claims

Claim ID	Patient	Payer	Amount	Denial Code	Reason	Denial Date	Status
CL-5502	Priya M.	New India	₹1,25,000	CO-4	Service not covered	08/05	Denied
CL-5488	Kiran K.	Star Health	₹45,000	CO-29	Duplicate claim	07/05	Appeal Filed
CL-5472	Lakshmi P.	HDFC Ergo	₹62,000	PR-1	Deductible not met	05/05	Won

Top Denial Codes

CO-4Not covered4

CO-29Duplicate3

PR-1Deductible3

OA-1Auth missing2

Appeal Submission

Claim ID

Appeal Reason

Supporting Docs

Upload Documents

Final Reports

Generate and export billing and RCM reports

Revenue Summary Report

Monthly / quarterly / annual revenue breakdown by department, payer, and category.

From

To

Claims & Settlement Report

Track all insurance and government scheme claims, settlements, and pending dues.

Payer Type

Denial Analysis Report

Analyse denial patterns by code, payer, and department to reduce future denials.

Period

AR Aging Report

Accounts receivable aging by payer and bucket with collection forecasts.

As of Date

Discharge Summary Report

Patient-wise discharge billing summary with payment status and outstanding dues.

Ward

Doctor Revenue Report

Revenue attribution per doctor including OP, IP, and procedure billing.

Doctor

Previously Generated Reports

Report Name	Type	Period	Generated By	Generated On	Format
Revenue Summary – April 2025	Revenue	01/04–30/04	S. Anveshana	01/05/25	PDF
Claims Report – Q4 FY25	Claims	Jan–Mar 2025	Finance	02/04/25	Excel
AR Aging – 30 Apr 2025	AR	As of 30/04	Billing Team	01/05/25	PDF

Discharge Management

Process patient discharges, clearances, and final handover

Pending Discharge

23

▼ 3 from yesterday

Discharged Today

18

Clearance Complete

14

Awaiting Bill Approval

9

Pending Discharge

Clearance Checklist

Discharge Summary

Discharge History

IPD No	Patient Name	Ward	Admitted	LOS	Doctor	Bill Status	Clearance
IPD-1001	Ravi Kumar	General	08/05/25	5d	Dr. Mehta	Finalised	Partial
IPD-1002	Sunitha Devi	Semi-Pvt	10/05/25	3d	Dr. Sharma	Pending	Not Started
IPD-1003	Naresh Babu	ICU	07/05/25	6d	Dr. Rao	Under Review	Not Started
IPD-1004	Latha Reddy	Private	09/05/25	4d	Dr. Rajan	Finalised	Complete
IPD-1005	Meena Kumari	General	11/05/25	2d	Dr. Nair	Unpaid	Not Started

Aadhaar-guided claim submission

Step 1 — Patient Registration

Step 2 — Digital Consent Collection

Step 3 — Aadhaar OTP Authentication

Step 4 — Government Scheme Eligibility

Step 5 — Pre-Authorization Request

Step 6 — Treatment Record & Approval Status

Step 7 — Final Claim Submission

Step 8 — Settlement & Closure

Claim Successfully Registered

Claim Process Flow Reference

Patient Registration

Consent Collection

Aadhaar OTP Authentication

Scheme Eligibility Check

Pre-Authorization Request

Cashless Treatment & Charge Recording

Claim Submission

Settlement & Payment

No Document Loaded

IPD No	Patient	Ward	Admitted	Discharged	LOS	Doctor	Bill Amt	Condition
IPD-0994	Anand Kumar	General	01/05/25	06/05/25	5d	Dr. Rao	₹22,400	Stable
IPD-0992	Ramesh Kumar	General	01/05/25	06/05/25	5d	Dr. Rao	₹22,400	Stable
IPD-0996	Saritha Bai	Private	03/05/25	07/05/25	4d	Dr. Nair	₹38,900	Improved
IPD-0998	Mohan Goud	ICU	02/05/25	09/05/25	7d	Dr. Mehta	₹1,12,000	LAMA
IPD-1000	Deepika Rao	Semi-Pvt	05/05/25	10/05/25	5d	Dr. Sharma	₹45,200	Stable
IPD-1004	Latha Reddy	Private	09/05/25	13/05/25	4d	Dr. Rajan	₹49,420	Stable