1. Basics concepts of healthcare revenue cycle management.
2. Revenue cycle management as a profession.
3. Claim submission process.
4. Collections and accounts receivables.
5. Denials and Bad debt management

1. Types of healthcare providers.
2. Medical practice staff.
3. Patient visit process.
4. Leadership.
5. Management.
6. Effective communication.
7. Efficiencies

1. Coding guidelines versus carrier guidelines.
2. Application of SBS, ICD-10-AM, and AR-DRG Coding guidelines.
3. Application of payer policies to coding guidelines.
4. Application of diagnosis coding to support medical necessity.

1. Overview of an office visit.
2. Patient Types.
3. Front desk responsibilities.
4. Collection of Demographics and insurance verifications.
5. Insurance Coverage validation.
6. Authorization form.
7. Encounter form.
8. Discharge Process/Check out

1. Standardization of benefits.
2. Co-Pay, Deductibles and Co-insurance.
3. Network categorization.
4. Pre-Approvals Protocols, Authorization Process & Validity of Pre-authorization Admitted care (Inpatient and Day Case) and non-Admitted care (OPD, Emergency, Primary Care).
5. Pharmacy Guidelines.
6. Non-Covered Pharmaceuticals.
7. Medication/Equipment/Consumables/Dispensing guidelines.
8. Referral Protocols.
9. Policy Exclusions.
10. Avoidable and unavoidable adjustments.
11. Root cause analysis by specialty.

1. Saudi billing methods and compliance standards.
2. Medical policies and payment policies as per KSA.
3. Billing methodologies per encounter type.
4. Saudi service codes.
5. Anesthesia reporting.
6. Contrast and Pharmaceuticals.
7. AR-DRG billing Admitted Care encounters (Inpatient and Day Case).
8. LOINC codes.
9. Dental coding.
10. Vaccines and toxoids.
11. Injection administrations.

1. Fee schedules.
2. Data entry.
3. Prior Authorization.
4. Claim scrubbers.
5. Technology and Claims submissions.
6. Hospital Facility Billing.
7. Primary Vs Secondary insurance.

1. Denials by denial type, count and associated Riyals.
2. Methods for preventing denials.
3. Account Receivable (A/R) Follow up.
4. Using Revenue Cycle and Billing Dashboards.
5. Factors affecting Revenue.
6. Collections from payers or patients.
7. Managing Deductibles and Co-insurance.

1. Types of Reimbursement.
2. Accounts receivable management.
3. Using key financial performance indicators and analysis.
4. General principles of billing.
5. The collection processes.
6. Using Explanation of Benefits (EOB) and remittance advice (RA) information.
7. The process of refunds and regulation.

Trainees are provided with various policies and source documents and asked to resolve a denial, find an error on a claim, and/or determine the next steps in the follow-up process based on the following documents provided:
o Claim forms
o Remittance advices
o Payment Policies
o Medical Policies (NCDs, Commercial medical policies)
o Appeal Letters
o Pre-authorizations
o Accounts receivable reports
o Claims follow-up reports

1. Fraud, Waste and Abuse.
2. Review of current regulations and applicable laws.
3. Apply coding to payment policy including Minimum data set (MDS) requirements as per MOH.
4. Identify forms used in billing and requirements related to those forms.
5. Specific Health Records requirements-(CBAHI).
6. Standards for Minimum Data specifications for Claims, Enrolled data, Codes, Admission, and discharge specialty reference codes. (CHI).

1. Quality Improvement.
2. Benchmarking.
3. Quality Healthcare Indicators.
4. Physician Quality reporting system.

1. Privacy rules and regulations.
2. Use of protected health information.
3. Best practices for Data Security.