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Revenue Cycle
management SPECIALIST

RCMS -KSA

Training Program

80

Hours course
Provided by AAPC & ANOVA
Endorsed by CHI

Program

Overview

The RCMS program provides and delivers an efficient and sustainable training program that explains the journey of a patient visit from the front desk till the patient is discharged/checked out from the facility and the submission of claim using insurance protocols, billing regulations, and medical codes till the point of reconciliations according to the Saudi healthcare regulations.

The Revenue cycle management specialist program includes lectures, reading assignments, practice exercises, module review tests, and a final exam.

Participants who successfully complete this course will be eligible to take AAPC’s credentialing exam to obtain the professional credential of RCMS.

About

AAPC

With over 220,000 members in 43 countries, AAPC is the world’s largest training and credentialing authority for medical coding, billing, and health information management professionals. 

AAPC is recognized by governments, employers, and association groups as the gold standard in medical coding and health information management.  AAPC offers 30+ professional credentials and certifications, and each year conducts over 60,000 certification exams in 3,700 locations around the world. 

Lessons:

  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.

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