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Inpatient Room Assignment Modes and Billing

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Dr M H B Ariyaratne edited this page Jun 7, 2026 · 1 revision

Inpatient — Room Assignment Modes and Billing Start Time

When a patient is admitted, the system can handle room assignment and the start of room-based billing in two distinct ways, controlled by a single configuration key. Understanding which mode your hospital uses is essential for correctly interpreting interim bills and for resolving queries from clinical or finance staff about when charges begin.

The Two Modes at a Glance

Mode 1 — Simultaneous (Default) Mode 2 — Deferred Ward Acceptance
Config key value true false
Room accepted at Admission desk, immediately Receiving ward, after the ward accepts the patient
Billing starts at Date and time of admission Date and time the ward clicks Accept
Transfer request created? No Yes — status Pending until ward accepts
Ward acceptance page needed? No Yes — Inpatient → Room → Accept Patients
Who controls billing start? Admission staff Ward nursing / reception staff

Configuration

Config key: Patient admission and room assignment are simultaneous processes.
Default value: true
Where to set it: Admin → Application Options — search for "simultaneous"

Screenshot: Admin → Application Options page filtered to "simultaneous", showing the toggle set to either true or false.

  • Set to true for Mode 1 — Simultaneous (the original, common behaviour).
  • Set to false for Mode 2 — Deferred Ward Acceptance.

Changing this key takes effect immediately for new admissions; it does not retroactively alter existing admissions.

Mode 1 — Simultaneous (Config = true)

This is the default. The room is assigned and immediately accepted during the admission process. No separate ward acceptance step exists.

Workflow

  1. Admission clerk opens Inpatient → Admissions → Patient Admit.
  2. Clerk fills in the admission form including the Room No field.
  3. Clerk clicks Admit.
  4. The system saves the admission, assigns the room, and sets:
    • PatientEncounter.roomAdmitted = true
    • PatientRoom.admittedAt = date and time of admission
  5. The clerk is taken directly to the Inpatient Admission Profile (BHT dashboard).

Screenshot: Admission form showing the Room No field completed, and the Admit button.

Screenshot: Inpatient Admission Profile opened immediately after admission.

Billing Implications

Room charges (bed rate, bundled timed services) start accumulating from the admission date and time recorded on the admission form.

If a patient is admitted at 10:00 AM and discharged at 4:00 PM the next day, room charges are calculated from 10:00 AM Day 1 to 4:00 PM Day 2.

On the interim bill, the room charge line will show admittedAt = admission date/time. Staff reviewing an interim bill in this mode can confirm the start time matches what was entered on the admission form.

Mode 2 — Deferred Ward Acceptance (Config = false)

In this mode, completing the admission form does not start room billing. A pending transfer request is created instead, and billing only begins once a ward staff member explicitly accepts the patient at the ward's acceptance page.

This mode is suited for hospitals where:

  • Admission is registered at a central desk while the physical bed is prepared separately.
  • Ward nursing staff confirm the exact time the patient arrives at the ward.
  • Finance policy requires billing to start only when the patient physically reaches the room.

Workflow — Admission Side

  1. Admission clerk opens Inpatient → Admissions → Patient Admit.
  2. Clerk fills in the admission form including the Room No field.
  3. Clerk clicks Admit.
  4. The system saves the admission and creates a Pending transfer request (type: Admission). It sets:
    • PatientEncounter.roomAdmitted = false
    • A PatientTransferRequest with status PENDING
  5. The clerk is taken to Inpatient → Room → Admit Room (not the BHT dashboard) because the room is not yet accepted.

Screenshot: After clicking Admit in Mode 2 — the system opens the Admit Room page instead of the BHT dashboard, because roomAdmitted is still false.

Workflow — Ward Acceptance Side

The receiving ward must explicitly accept the patient to start billing.

  1. Ward staff open Inpatient → Room → Accept Patients
    (or navigate to the Admission Profile Dashboard → Room Management → Accept Patients).
  2. A list of Pending Patients is shown for the current department.

Screenshot: Accept Patients page showing a pending admission with BHT No, Patient Name, Type = "Admission", From = "Admission Desk", and the To Room column.

  1. Staff review the Accepted At date-time picker for each pending patient. This field defaults to the current time but can be adjusted to reflect the actual time the patient arrived at the ward.
  2. Staff click Accept (with a confirmation prompt).
  3. The system:
    • Sets PatientTransferRequest.status = ACCEPTED
    • Sets PatientEncounter.roomAdmitted = true
    • Sets PatientRoom.admittedAt = acceptedAt (the time the ward set in the date-time picker)
  4. Staff are taken to the BHT dashboard for that admission.

Screenshot: Accept Patients page with the Accepted At date-time picker visible, and the Accept / Cancel action buttons.

Screenshot: Confirmation dialog "Accept this patient?" before acceptance.

Billing Implications

Room charges start accumulating from the Accepted At date and time, not from the admission date.

Example: A patient is admitted at 09:00 AM. The ward accepts the patient at 10:30 AM (when they physically arrive at the ward). Room billing starts at 10:30 AM, not 09:00 AM.

On the interim bill, the room charge line reflects admittedAt = ward acceptance time. If the interim bill shows charges starting at a different time than when the patient was registered at admission, this is expected and correct behaviour in Mode 2.

Interim Bill — How Charges Are Calculated

Regardless of mode, the interim bill always uses PatientRoom.admittedAt as the start of the billing period for each room segment.

Room Charge Formula

Room charge = (Rate per unit) × (Number of billable units between admittedAt and billing time)

The billable unit (hours, calendar days, etc.) is defined per room category in the timed services configuration.

Multi-Room Stays

If a patient transfers between wards or rooms during their stay:

  • Each room segment has its own admittedAt (start) and dischargedAt (end).
  • In Mode 2 (Deferred), the start of each segment is the acceptance time at the receiving ward.
  • The interim bill lists each room segment separately.

Screenshot: Interim bill showing two room segments (e.g., General Ward followed by ICU), each with their own start and end times and charge totals.

Common Interim Bill Confusion

Observation on Interim Bill Mode 1 Explanation Mode 2 Explanation
Room charges start exactly at admission time Expected — billing is simultaneous with admission Should not happen; check if config key is set correctly
Room charges start later than admission time Room may have been changed/transferred Expected — this is the ward acceptance time
No room charges at all Patient may not have a room assigned yet Ward has not yet accepted the patient
Room charges start at an unexpected past time Admission time may have been backdated Ward acceptance time may have been manually backdated

Navigation Summary

Action Page Config mode
Admit a patient Inpatient → Admissions → Patient Admit Both
Manually admit room (deferred only) Inpatient → Room → Admit Room Mode 2 only
Accept pending patients (ward side) Inpatient → Room → Accept Patients Mode 2 only
View interim bill Inpatient → Billing → Interim Bill Both
Change accepted-at timestamp Accept Patients page date-time picker, before clicking Accept Mode 2 only

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