Healthcare Revenue Advisors THE REVENUE CYCLE MANAGEMENT COMPANY. COMPANY PROFILE
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1 THE REVENUE CYCLE COMPANY COMPANY PROFILE
2 GulfHRA, is an established UAE based Revenue Cycle Company since 2013, providing innovative revenue solutions in compliance with DHA, HAAD, and MOH guidelines to healthcare providers, payers and government healthcare bodies. Definitions: Revenue Cycle GulfHRA s Revenue Cycle solutions help maximize workflow, enhance productivity, improve revenue, realize cost savings and increase compliance, by increasing efficiency through Consultancy, Training, Practice and Outsourcing. The Revenue Cycle is defined as the process by which services including all administrative, financial and clinical functions are provided charts coded, charges billed/submitted and cash generated a combination of all administrative, financial and clinical functions to contribute to the capture, billing, collection and management of patient service revenue. Mission The Revenue Cycle covers a large spectrum of functions to procure cash flow for hospitals and health systems in a transparent and reliable way. To enhance performance and value through practical innovative services to our clients, focused on dynamic excellence within the market. RCM Explained: Vision Patient Access Medical Documentation Of Services Receivables Customer Service Excellence optimized and inspired. Scheduling Care Delivery Charge Master Claims Editor Payment Posting Customer Inquiries Pre- Registration Case Transcription Bill Reconciliation Secondary Issue Resolution Training Practice Eligibility & Verification Utilization Coding/ CDMP Claims Submission Follow-Up Financial Counseling Discharge Planning Charge Capture Contractual Adjustments Appeals/ Denial Mgmt Registration Patient Discharge Late Charges Patient Statements Bad Debt/ Write Offs Consultancy SERVICES Outsourcing Legal Collections Feedback 1 2
3 REVENUE CYCLE Definition: RCM is a process by which services are provided, charts coded, charges billed/submitted and cash generated. PROJECT PHASE: Contract /Consulting Planning Negotiations Training/Support Pricing studies (DRG, Base rates) Market benchmarking Initiation and negotiation of Payer Contracts Design and optimize internal functions and processes Resource planning Outsourcing; Outsourcing is a practice used by different companies to reduce costs by transferring portions of work to outside suppliers rather than completing it internally. Outsourcing is an effective cost-saving strategy when used properly. Practice Stakeholders: Revenue cycle Managers Health Information Managers Clinical Stakeholders IT Managers Coders Billers Finance Communication Integration Practice management through Gulf-HRA can be utilized either partial, complete, or as a whole RCM package. Capture patient demographics. Schedule appointments. Preregister patients (including insurance eligibility and benefit checks). Determine patient financial responsibility for collections at the point of care. Maintain insurance payer lists. Perform coding and billing. Generate and action reports. Implement accounts receivable follow-up, including paid claims, unpaid claims, denied claims, insurance collections and patient collections. Automated process and solutions can provide definitive value addition to the organization s business objectives and to ensure reaching them in a shorter duration. Stakeholders: CEO CFO Directors of RCM Business Development Payers FULL OR PARTIAL INTEGRATION OPERATIONS Consulting Outsource Training Our highly experienced consultants can assist you with: Change Resource management Growth consulting Risk management End-process management and support. Payer facilitation Our team is: Fully certified Minimum 2 years post certification experience Continuously educated Completely pre-placement orientated Billers Coders HIM specialist Denial Specialists CDI specialists Contract management specialists All specialized RCM functions and services: Specialized services: Coding (Certification) E&M IP OP ED Resubmissions Denials Case Health Information ) Health Information Governance)- CDI (Clinical Documentation Improvement). Financials in RCM Contract (Payers and Third Party Administrators). Registration components in RCM. Payer feedback and negotiation (nosology utilization). 3 4
4 CHANGES Our Services Communicating Change in the Revenue Cycle 1. Consulting Objective: Optimize quality standards, proficiency and returns in the RCM process. Specific Consulting Services through a) Change Change management is the discipline that guides how we prepare, equip and support individuals to successfully adopt change in order to drive organizational success and outcomes. Identify actual/ potential problems in RCM cycle. PLANNING Benchmark base performance to industry standards. Develop Reports. IMPLEMENTATION Process improvement to eliminate problem. Implement Changes, Set Productivity & Provide feedback. SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE Continually monitor performance. Analysis: Audits, interviews, process control, outcome, return on investment, project viability. Reporting and Strategy: Focused on key decision makers key operational representatives and important decisions. Process Optimization: Revenue cycle enhancement. Communication: RCM ergonomics, flow, objectives vs tasks and responsibilities. Clinical Optimization: Improved workflows. Improved Human Resource pool. Maximize usage of features of EHR/EMR system. Optimize and standardize documented processes. Align EHR/EMR with strategic goals. Optimal collaboration between clinicians and HIM. Coordinate information flow between departments. Benchmark within new healthcare environment. Financial outcomes (gap analysis, resource optimization, margins). PRE-SERVICE SCHEDULING INSURANCE ELIGIBILITY VERIFICATION INBOUND SERVICE AUTHORIZATION POINT OF SERVICE CHECK-IN REGISTRATION POS COLLECTIONS CHARGE ENTRY CARE VIRTUAL CLINICAL DOCUMENTATION CARE COORDINATION CLINICAL DATA POST-SERVICE CODING SERVICES CLAIM SCRUBBING CONCURRENT EVALUATION BILLING & COLLECTIONS PAYMENT POSTING A/R FOLLOW-UP DELINQUENT ACCOUNTS INSURANCE FOLLOW-UP ANALYSIS FINANCIAL RECONCILIATION PERFORMANCE REPORTING DASHBOARDS A/R ACCOUNT OVERSIGHT APPEALS CONTRACT PRIORITIZE THE APPROVE THE WORKFLOW BUILD THE CHANGES TEST & VALIDATE THE CHANGES REFERRAL OPTIMISE CARE DELIVERY CLAIM RECONCILIATION CLAIM RESOLUTION DENIAL & RESOLUTION REFUNDS & OVERPAYMENTS INSIGHT REPORTING CODING AUDITS TRAIN THE END USERS Enhanced Cash Flow Increased Practice / Provider Revenue RESULT Fewer Rejections & Denials Fewer Write-off s FSET THE OUNDATION SUPPORT & FOLLOW UP 5 6
5 b) Business and Financial Competency Growth In business, growth is not an option, it is imperative. We help you focus on this from the business perspective. Expand market relevance (Expand business models and know the impact of RCM on the forecasted growth). Margins (Managing Margins create a safe environment for staff and decision makers). Payment Integrity Price Transparency Business Office Suite Patient Access Revenue Optimization c) Risk : Forecasting and evaluation of financial risks with identification of procedures to avoid or minimize their impact on business objectives. Segregated versus Integrated functions. 2. Training Objective: Optimize Human Resource pool both for internal and external stakeholders. Leak Financial implications Standards RCM Function Support SCOPE Specialized Services Certifications d) End - Process Analysis and Support: Auditing Establish gaps (front end facilitation to back end functions). DRG/E&M accuracy reports (Up-coding and Down-coding). Identify Problem accounts to decrease A/R Days and Lower Credit balances. Denial Pre-service (Registration, pre-authorization). Point of service (Physician, case managers, coders, billers, HIS, HIM). Care (Mid ). Post Services (Reconciliation) and Collections (Denials, Business office, Finance department). Analysis Accounts Receivable. Coding E&M IP OP ED Case HIM (Health Information ) HIG (Health Information Governance). CDI (Clinical Documentation Improvement). Payer contract negotiations. Financials in RCM Contract (Payers and Third Party Administrators). Registration components in RCM. Negotiation Criteria (nosology utilization). 7 8
6 Methodology: a) Informal: Training sessions, team development, leadership, meetings, discussions, brainstorm, debates. b) Formal: Certification, development, communicative, HR team development, seminars and orientation sessions. In addition to information and education, there are new possibilities surrounding the use of web based, user-friendly, and secure networked technologies in healthcare. Revenue Cycle in UAE is evolving at a rapid pace, in tandem and coupled, with information technology, and the organization has to set sight on the potential benefits that can be tapped. c) Face to Face: Scheduled specific (webinars, cohort sessions). Scheduled day long informational sessions (Marketing/Networking/Branding /Market PREP for new initiations). Scheduled course/contractual (CDI, Accelerated Development, Stakeholder development). d) Online training: Deliver360 Deliver Deliver Learning System Secure Online Test Delivery Platform Benefitting Stakeholders: Department Senior Managers, Managers and Assistant Managers. Practice Directors and Chief Officers. Finance Officers and Finance Managers. Operations and Proficiency support. New Market 9 10
7 Deliver360 is a web-based, user-friendly and secure application to aid in physicians, medical coders and billers to improve education capabilities and improve clinical documentation leading to increased revenues and enhancing patient safety. TARGET AUDIENCE INTERNAL EXTERNAL 3. Practice Practice can be defined as a subset of outsourcing services that involves the contracting of the day-to-day operations and responsibilities of specific medical practice office functions (or processes) to a service provider. Objectives: Learning System to improve and enhance coder/biller skills and accuracy utilizing q Deliver question pool. Pre-boarding employees for induction and orientation purposes. Delivery of training focused to coders, via recorded webinars or media. Physicians: to improve their clinical documentation methodologies to enhance respective outcomes. Professional development: Coder and billers looking forward for certification(s) in their career via globally recognized bodies as AAPC or AHIMA. To create a scenario of eliminating hidden costs, less leakage and losses, increase bottom line profits and streamline HR and internal management processes. This in essence leads to less liability, and more defined experience to the business at lower cost rates. Methodology: Streamlined practice management revolves around four core principles: Modules are categorized into multiple specialties for physicians and allied healthcare professionals as coders and billers. Physician content is focused on Clinical Documentation Improvement per specialty and commonly triggered conditions. Content used is approved by licensed accreditation bodies. Facility specific and customized content to be developed to suit the needs of an institution. Incorporation of a pay and use model. Affiliation and/or accreditation with a certification body such as AAPC or AHIMA for co branding purposes. Features Pre-boarding induction modules for on-boarding employees. Creation of institution specific classrooms/login s for multiple users. Access provided to the LMS Deliver ccccc blog for latest updates and news relating to the industry. Access provided to LMS forum under an alias for privacy purposes. All blog and forum content is moderated by GulfHRA. Wide range report generation for administrator(s)/course creator/user. A vast pool of questions developed by GulfHRA for DeliverQu, that are specifically focused on testing users for the UAE market. Deliver Scheduling Eligibility check Pre-Registration Risk Outcomes Front-Desk Registration PROCESS Resources Financial Counseling PROVIDER EXPERIENCE PEOPLE TECHNOLOGY Maximize revenue and compliance by: Coding Capturing Charge Discharge Processing Cashiering 1. Eliminating delayed claim submissions. Processing Claims Remittance Processing RESULTS Efficiency Improved Customer Service Improved Quality Ease of Access 2. Reducing rejections percentages and claim denials. 3. Eliminating missing claims. PROCESS PAYER EXPERIENCE PEOPLE TECHNOLOGY Denial Processing RESULTS Improved Claim Accuracy Prompt Account Resolution Increased Collections Third-Party Follow-Up Payer Payment Analysis Collection Agencies Self-Pay Collection Customer Service 11 12
8 Practice through GulfHRA can be utilized either partial or as a whole RCM package; 4. Outsourcing Capture patient demographics. Schedule appointments. Pre-registration and verification of patients (including insurance eligibility and benefit checks). Determine patient financial responsibility for collections at the point of care. Maintain insurance payer lists. Perform coding and billing services. Generate customized reports. Implement accounts receivable follow-up, including paid claims, unpaid claims, denied claims, resubmission and insurance collections. We do the best when it comes the saying "Do what you do best and outsource the rest", which has become an internationally recognized business tag line. Objectives: Outsourcing is a practice used by different companies to reduce costs by transferring portions of work to outside suppliers rather than completing it internally. Outsourcing is an effective cost-saving strategy when used properly. Methodology: Automated processes and solutions can provide definitive value addition to the organization s business objectives and ensure sustainable and efficient outcomes. department completes billing and submits claim Payments received and claim closed Back office staff treats patient PT schedules appointment PT checks in for appointment and completes all intake requirements Stringent pre-testing and interviewing insure a corporate pool of highly focused and experienced staff are initiated into our team regularly. We fully comprehend the specific needs within the UAE RCM market and as such provide specific candidates that will optimize proficiency as from day one of placement. Our experienced team consists of highly qualified, AAPC/AHIMA certified Revenue Cycle staff (Coders, Billers, Denial, HIM and CDI specialists). All specialized staff members possess a clinical background, two years post certification experience and are exposed to local standards and guidelines. We are highly focused on continuous education through our internal training programs Deliver360 and eliverqu Deliver and adapt our HR processes in accordance with your company needs. Being highly elastic is one of core competencies; we can match our client s requirements swiftly with reduced turn-around-times for assured delivery. We will serve all your RCM requirements in compliance with the specified standards
9 Contact us: Abu Dhabi Tamouh Tower Al Reem Island P.O.Box: 4495 enquiries@gulf-hra.com Dubai Boulevard Plaza Tower 1 Downtown Dubai P.O.Box:
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