Overview
With a healthcare system that keeps evolving, it’s not impossible to have an in-house RCM team, the complexities and constraints involved can make it stressful and time-consuming for healthcare providers, and can shift their focus from the core task of providing care to their patients.
Hiring specialized RCM service providers like Champions Health ideally offers several benefits and multiple advantages in Medical and Dental Empanelment, Coding, Billing and comprehensive end-to-end solutions.
Our coding standards are well maintained to meet the requirements of
Department of Health -DOH (formerly HAAD – Abu Dhabi, Dubai Health Authority – DHA (Dubai), and Ministry of Health -MOH (Sharjah and Northern Emirates).
End-to-end RCM
Our expertise in RCM includes our unique domain knowledge about the several modules that need to be managed perfectly to ensure financial security and viability for our healthcare clients. It includes specialized and seamless management of all administrative and clinical functions, processes, systems, and software applications that are part of the healthcare industry’s elaborate revenue cycle. We utilize the right metrics and analytics to keep track of the key processes and stringently follow the best practices to ensure the best outcomes, always.
What do we do
- Insurance Empanelment/
Contracting - Clinical
Documentation - Medical Coding
and Billing - Medical Claims
Submission - Rejections and Denial
Management - Reconciliation and
Payment Follow up
Insurance Empanelment/Contracting
Considerable changes in UAE healthcare have created an increase in demand for new Healthcare Insurance Empanelment and agreements to sustain business. As a Revenue Cycle Management Company, we assist & support you in all ways to find the best and suitable payer for you.
Due to a lack of awareness in Insurance contracts, most of the facilities are signing without challenging and negotiating the key points. As an expert, we assist you to note the mandatory checkpoints in all contract management from payers.
Determining the Payer
The complete analysis of the client location, customer type, Medical Specialties available in the facility, etc. will be conducted by our experts before initiation the insurance Empanelment.
Once the client’s requirements are clearly noted, the list of payers will be advised as suitable to client needs. Upon confirmation, the process will be initiated and required documents will be prepared to go forward with the application.
Completing the Application
The time frame to complete the application will be well maintained. Each and every stage will be informed to the client. Timely follow up will be ensured.
Reviewing the Contract terms & price
We will update you on each and every terms and conditions of the contracts.
The tariff proposed by payers for your services will be discussed and confirmed through panel meeting with your authorized staff to meet the financial strategies
Exclusion list / coverage criteria’s / Schedule of benefits will be notified to the payer
Any Objections & Negotiations of covered / non covered services & fees schedules will be notified to the payer
Signing Contract
Once both the parties agree to the contractual terms and conditions, the authorized signatory of the facility will be introduced to sign the agreement.
Renewal policy and procedures will be discussed and informed.
Training of Payer portals & policies
We believe that the Insurance Empanelment service is not completed until the proper training to facility staffs is provided.
Introduction / crosswalk to payer’s online portal will be done by our Revenue Cycle Management experts, required training will be provided on regular basis.
Clinical Documentation
Clinical Documentation plays a crucial role in patient care. A claim is validated by the documentation, not only with the treatment delivered but each and every keyword in it is important in optimizing the claims processing.
As a Revenue Cycle Management partner, we guide you in each clinical document keyword in all specialties of healthcare facility.
Consultants will analyse the facility’s documents and provide detailed reports on the areas to be improved, in addition to the necessary training that will be provided to the concerned professionals for improving the clinical documentation standards.
Medical Coding and Billing
The Medical Coding & Billing processes are the next major steps resulting in proper financial flow hence advisable to be handled by expertise RCM team. We provide end-to-end services of coding and billing for all our clients with excellent results. Our experts are a promising team of accurate coding of Diagnoses & procedures with CPT, ICD10 CM, USCLS, IR-DRG & CDT (Dental) codes. We closely and rigorously monitor and follow the guidelines from DHA (Dubai), DOH (HAAD – Abu Dhabi), and MOH are followed by our coding experts to avoid any delay in reimbursement.
We provide our best offers for both EMR & Non-EMR (Paper claims) facilities.
We are Champions since we bring in miraculous results to our clients with the help of our experts and user-friendly Software Applications to connect with client data. This will ensure the healthcare data is accessed in a secure way.
Our expert Medical Coding and Billing includes,
- The accuracy & highly specific ICD 10 cm & CPT codes in all Medical & Dental claims
- Guiding & Co-coordinating with Pre-approval team
- Well-designed physician query process
- Monthly / weekly / daily MIS reports are provided as per the client requirements
Our Medical coders are well versed in below portals and HIS software’s in UAE healthcare industry.
- Insta
- Shade
- Prosoft
- Clinic soft
- E-claim link-dubai
- & many others
Medical Claims Submission
After ensuring proper audit of the coded and billed data, claims are eligible for Medial Claims Submission
The submission process includes
- Verifying the insurance card numbers & plans,
- Eligibility checking
- Pre authorization checking
- Verification of all medical codes for accuracy, and specificity
- Checking of transmission / XML errors.
- Submitting the claims in Turn Around Time (TAT) time.
- Payer confirmation status upon submission of claims.
Rejections and Denial Management
The vital cause of revenue loss in healthcare is due to the Rejections of the submitted claims. Our industry experts are able to prevent these rejections upfront with the experience they hold.
We as a Revenue Cycle Management team can afford you the best denial management services by our experts who have updated knowledge of the latest trends in rejections from all payers.
Our service includes:
- Re-submitting the denied claims with proper justification on time.
- Identifying the accurate root cause of denials.
- Preparing & submitting detailed reports for the Client Management.
- Listing the denials into Medical & Administrative (Non-Medical) categories.
- Training the concerned staff/s immediately to avoid future rejections.
- Guiding & Implementing the necessary actions & checkpoints to stop administrative rejections
- Monitoring the effectively implemented process for any deviation
- Providing comparison reports to the client to show progress.
Reconciliation and Payment Follow up
Reconciliation of the Medical Claims can be done as per the agreed timeline fixed by insurance companies. The process can be done for both EMR & Non-EMR based facilities.
The detailed analysis of claims in all aspects will be done by our RCM consultants.
The process includes,
- Categorizing real & eligible Medical claims for reconciliation.
- Segregating insurance-wise data with number of claims and pending amount
- Explaining the prepared data to the client management
Upon effective reconciliation process, the payment follow up with insurance companies will be handled by our dedicated consultant. Each insurance companies have their own style of data requirements while proceeding payment follow up.
We are well updated with those required data key points. Thus we initiate & approach the payers with accurate data to gear up the payment.
Benefits of partnering with us
- Access to expert-built RCM system that offers maximum accuracy and efficiency across the revenue cycle, ensuring quicker turnarounds
- Maximum cloud-based security of information accessed from providers’ EHR portal and accounting platforms
- Simpler and efficient tracking capabilities that minimize denials and maximize reimbursements
- Achievement of desired outcomes through a future-ready, analytics-driven solution that leverages advanced capabilities
