GulfHRA company profile · Master Transcription Coding/ CDMP Charge Capture Late ... process control, outcome, return on investment, ... Amity Health LLC MSH International

The Revenue Cycle Management Company

COMPANY

PROFILE

www.gulf-hra.com

ealth Information Technology evenue Cycle Management dministrative Support

SERVICESConsultancy Outsourcing

Training PracticeManagement

Vision

Mission

To enhance performance and value through practical innovative services to our clients, focused on dynamic excellence within the market.

Excellence – optimized and inspired.

GulfHRA, is an established UAE based Revenue Cycle Management Company since 2013, providing innovative revenue

solutions in compliance with DHA, HAAD, and MOH guidelines to healthcare providers,

payers and government healthcare bodies.

GulfHRA’s Revenue Cycle Management solutions help maximize workflow, enhance productivity,

improve revenue, realize cost savings and increase compliance, by increasing efficiency through Consultancy,

Training, Practice Management and Outsourcing.

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Revenue Cycle Management

Definitions:

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.

The Revenue Cycle covers a large spectrum of functions to procure cash flow for hospitals and health systems in a transparent and reliable way.

PatientAccessPatientAccessPatientAccess

Medical Documentation

OfServices

BillingReceivables

ManagementCustomerService

Scheduling

Registration

Pre-Registration

Eligibility &Verification

FinancialCounseling

CareDelivery

CaseManagement

UtilizationManagement

DischargePlanning

PatientDischarge

ChargeMaster

Transcription

Coding/CDMP

ChargeCapture

LateCharges

ClaimsEditor

BillReconciliation

ClaimsSubmission

ContractualAdjustments

PatientStatements

PaymentPosting

SecondaryBilling

Follow-Up

Appeals/Denial Mgmt

Bad Debt/Write Offs

LegalCollections

CustomerInquiries

IssueResolution

Feedback

RCM Explained:

2

ealth Information Technology evenue Cycle Management dministrative Support3

REVENUE CYCLE MANAGEMENT

Definition:RCM is a process by which services are provided, charts coded, charge sbilled/submitted and cash generated.

PROJECT PHASE: OPERATIONS

Communication Integration

Contract Management/Consulting

Pricing studies (DRG, Base rates)

Market benchmarking

Initiation and negotiation of Payer

Contracts

Design and optimize internal

functions and processes

Resource planning

Planning

Negotiations

Training/Support

Practice Management

Consulting Outsource Training

Stakeholders:

Revenue cycle

Managers

Health Information

Managers

Clinical Stakeholders

IT Managers

Coders

Billers

Finance 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

specialistsPractice 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.

CEO

CFO

Directors of RCM

Business

Development

Payers

Stakeholders:

All specialized RCM functions and services:

Coding (Certification)

E&M

IP

OP

ED

Resubmissions

Denials

Billing

Case Management

Health Information

Management) –

Health Information

Governance)-

CDI (Clinical

Documentation

Improvement).

Financials in RCM

Contract Management –

(Payers and Third Party

Administrators).

Registration components

in RCM.

Payer feedback and

negotiation (nosology

Specialized services:

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.

Our highly experienced consultants can assist you with:

Change

Management

Resource

management

Growth

consulting

Risk management

End-process

management and

support.

Payer facilitation

FULL OR PARTIAL INTEGRATION


Our Services

1. Consulting

PRE-SERVICE POINT OF SERVICE

CAREMANAGEMENT

POST-SERVICE BILLING &COLLECTIONS

ANALYSIS A/R MANAGEMENT

ACCOUNTMANAGEMENT

OVERSIGHT

APPEALSMANAGEMENT

CONTRACTMANAGEMENT

FINANCIAL RECONCILIATION

PERFORMANCEREPORTING

DASHBOARDS

INSIGHTREPORTING

CODING AUDITS

PAYMENTPOSTING

INSURANCEFOLLOW-UP

A/R FOLLOW-UP DELINQUENT ACCOUNTS

REFUNDS &OVERPAYMENTS

DENIAL MANAGEMENT& RESOLUTION

CLAIM SCRUBBING

CONCURRENTEVALUATION

CLAIMRECONCILIATION

CLAIMRESOLUTION

CLINICAL DATAMANAGEMENT

VIRTUAL CLINICALDOCUMENTATION

OPTIMISE CAREDELIVERY

CARECOORDINATION

CHECK-IN REGISTRATION

POS COLLECTIONS

CHARGEENTRY

CODING SERVICESSCHEDULING

REFERRALMANAGEMENT

INSURANCE ELIGIBILITYVERIFICATION

INBOUND SERVICEAUTHORIZATION

SYSTEM ADMINISTRATION, PM DATABASE CONFIGURATION, WORKLOG MANAGER, TRAINING, CLIENT CUSTOMER SERVICE

Optimize quality standards, proficiency and returns in the RCM process.

Objective:

Specific Consulting Services through

a) Change Management

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.

Benchmarkbase performance

to industry standards.Develop

ManagementReports.

Process improvement to eliminate

problem.

ImplementChanges, SetProductivity

& Provide feedback.

Continuallymonitor

performance.

PLANNING IMPLEMENTATION

RESULT

Enhanced Cash Flow Increased Practice /Provider Revenue

Fewer Rejections &Denials Fewer Write-off’s

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Communicating Change in the Revenue Cycle

SET THE

FOUNDATION

PRIORITIZE TH

E

CHA

NG

ES

WORKFLOW

AP

PROVE THE CHANGES

THE CHANGES

TEST & VALIDATE

TRA

IN T

HE

E

ND

USE

RS

SUPPORT &

FOLLOW

UP

BUILD THE

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).

Analysis:

Audits, interviews, process control, outcome, return on investment, project viability.

Focused on key decision makers – key operational representatives and important decisions.

Revenue cycle enhancement.

RCM–ergonomics, flow, objectives vs tasks and responsibilities.

Reporting and Strategy:

Process Optimization:

Communication:

Clinical Optimization:

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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.

Forecasting and evaluation of financial risks with identification of procedures to avoid or minimize their impact on business objectives.

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 Management

Payer contract negotiations.

Segregated versus Integrated functions.

Leak Management

Financial implications

Standards

Certifications

Margins (Managing Margins create a safe environment for staff and decision makers).

Payment Integrity

Price Transparency

Business Office Suite

Patient Access

Revenue Optimization

Expand market relevance (Expand business models and know the impact of RCM on the forecasted growth).

c) Risk Management:

d) End-Process Analysis and Support:

6


List of Insurance Companies

Daman (Network I & 2 plus Thiqa)Saudi Arabian Insurance Company (SAICO)Emirates AirlinesGood Health (An Aetna Company)Amity Health LLCMSH InternationalAXA HealthcareNational General Insurance Co. (NCI)GlobemedADCO (Abu Dhabi Company Oil)GASCO (Abu Dhabi Gas Industries)Wapmed TPAInayah TPA

Al Dhafra Insurance CompanyAl Ittihad Al-WataniAl Wathba Insurance CompanyArab Orient Insurance CompanyDubai National Insurance CompanyNASCO KaraogianRas Al Khaimah National Insurance Company

ACE LifeAbu Dhabi National Takaful CompanyAl Dhafra Insurance CompanyAl Hilal TakafulAl Ittihad Al WataniAl Wathba Insurance Company - Morgan PriceAl-Ain Ahlia Insurance CompanyDubai Islamic Insurance & Reinsurance Company (AMAN)Emirates Insurance Co.Green Crescent Insurance CompanyKuwait - Qatar Insurance Company - KuwaitLebanese Insurance Company (S.A.L.)Noor TakafulPresidential Flight - Abu DhabiQatar Insurance Company - QatarRAK BankRas Al Khaimah National InsuranceSalama Islamic Arab InsuranceSharjah Insurance CompanyAl Muthanna Takaful - KuwaitTazur Takaful Insurance Co - KuwaitTazur Takaful Insurance Co - BahrainBahrain & Kuwait Insurance Company - BahrainBoubyan Takaful Insurance Company - KuwaitOracleMed Health (Pty) LtdALICO - Weatherford Oil Tools Co. - LibyaVision Oman - OmanAl Madina Insurance Company-OmanGulf Takaful - KuwaitTakaful Emarat

1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950

Qatar Insurance CompanyThe Tokio Marine & Fir Insurance Company Ltd.Arabia Insurance CompanyQatar Insurance CompanyRoyal & Sun Alliance (Middle East) Limited E.C. Dubai BranchJordan Insurance companyAL Fujairah National Insurance CoSALAMA (ISLAMIC Arab insurance Co)Al Ahlia Insurance Company SAOCAllianz Worldwide Care (AWC)Bahrain Kuwait Insurance CompanyDubai Islamic Insurance & Reinsurance Company (AMAN)Expat Services GmbH Dubai Branch (ESDB)Government of DubaiMuscat Life Assurance Company SAOCOman Qatar Insurance Company (OQIC)Qatar Insurance Co (QIC)The New India Assurance Company Ltd (NIA)William Russell LimitedDubai Islamic Bank (DIB)Dubai WorldHilton International HotelsAbu Dhabi National Takaful coAl Fujairah National Insurance Company PSCAl Hilal Takaful CoAl Ittihad Al Watani GICAl Wathba National Insurance CoAl Saqr Saudi KSAInayah Commercial BrokersNew India Insurance CoADNIC (TPA)Warba Insurance Co.Ritaj Takaful Insurance Co.Al Muthanna Insurance Co.International Takaful Insurance Co.InterGlobal Insurance Co. (UK)Securite AssuranceGhazal Insurance Co.Al AM Ahlia Insurance Co.AXAALICONASMednet (TPA)Neuron (TPA)Nextcare (TPA)WAPMED

53545556575859606162636465666768697071727374757677787980818283848586878889909192939495969798

The Tokio Marine & Fir Insurance Company Ltd.Arabia Insurance Company

5152

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2. Training

Pre-service (Registration, pre-authorization).

Point of service (Physician, case managers,

coders, billers, HIS, HIM).

Care Management (Mid Management).

Post Services (Reconciliation)

Billing and Collections (Denials, Business

office, Finance department)..

Analysis

Accounts Receivable Management.

Coding E&M IP OP EDBillingCase ManagementHIM (Health Information Management) – HIG (Health Information Governance).CDI (Clinical Documentation Improvement).Financials in RCMContract Management – (Payers and Third Party Administrators).Registration components in RCM.Negotiation Criteria (nosology utilization).

RCM Function Support Specialized Services

Objective:

Optimize Human Resource pool both for internal and external stakeholders.

SCOPE

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a) Informal:Training sessions, team development, leadership, meetings, discussions, brainstorm, debates.

b) Formal:Certification, development, communicative, HR team development, seminars and orientation sessions.

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:

Department Senior Managers, Managers and Assistant Managers.Practice Directors and Chief Officers.Finance Officers and Finance Managers.Operations and Proficiency support.New Market

Benefitting Stakeholders:

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Deliver 360

DeliverDeliver

Learning Management System

Secure online test delivery platform

Methodology:

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 Management 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.



Deliver 360 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.

Learning Management 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.

INTERNAL EXTERNAL

Features

Modules are categorized into multiple specialties for physicians and allied healthcare professional¬s as coders and billers.

Physician content is focused on Clinical Documentation Improvement per specialty and commonly triggered conditions.

Facility specific and customized content to be developed to suit the needs of an institution.

Affiliation and/or accreditation with a certification body such as AAPC or AHIMA for co branding purposes.

Pre-boarding induction modules for on-boarding employees.

Creation of institution specific classrooms/login’s for multiple users.

Access provided to the LMS’ ccccc blog for latest updates and news relating to the industry.

All blog and forum content is moderated by GulfHRA.

Wide range report generation for administrator(s)/course creator/user.

Access provided to LMS’ forum – under an alias for privacy purposes.

Incorporation of a pay and use model.

Content used is approved by licensed accreditation bodies.

A vast pool of questions developed by GulfHRA for DeliverQu, that are specifically focused on testing users for the UAE market.

TARGET AUDIENCE

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Deliver

Deliver

Deliver


3. Practice Management

Practice Management 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:

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:

PROVIDEREXPERIENCE

PAYEREXPERIENCE P

ROCE

SS

PRO

CE

SSPEOPLE

PEOPLE

TECHNOLOGY TECHNOLOGY

Improved Claim AccuracyPrompt Account ResolutionIncreased Collections

EfficiencyImproved Customer ServiceImproved QualityEase of Access

DischargeProcessingCashiering

Sche

dulin

gEl

igib

ility

che

ck

Pre

-Reg

istrati

on

Front-Desk

Registration

Financial Counseling Coding

Charge

Capturing

Claims

Processing

Remittance

Processing Denial Processing Third-Party

Follow-Up

Payer Pay

men

t

A

nalysis

Cust

omer

Serv

ice

Sel

f-Pa

y Co

llecti

onCo

llecti

onA

genc

ies

Risk

Man

agem

ent

O

utco

mes

Resources

Streamlined practice management revolves around four core principles:

1. Eliminating delayed claim submissions.2. Reducing rejections percentages and claim denials.3. Eliminating missing claims.

Maximize revenue and compliance by:

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RESULTS

RESULTS


Practice Management through GulfHRA can be utilized either partial or as a whole RCM package;

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.

Automated processes and solutions can provide definitive value addition to the

organization’s business objectives and ensure sustainable and efficient

outcomes.

Paymentsreceived and claim closed PT schedules

appointment

PT checks in forappointmentand completesall intakerequirements

Back office stafftreats patient

Billingdepartmentcompletesbilling andsubmits claim

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4. Outsourcing

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:

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 Management staff (Coders, Billers, Denial Management, 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 – Deliver 360 and eliverQu – 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.

14

Deliver


Through fresh new solutions, GulfHRA will walk side by side with you

through the process of establishing, changing or enhancing your Revenue Cycle

with the best profit outcome, staff and resource pool, and professional service quality

with maximum compliance.


Our Clients:

16

Contact us:

[email protected]

+971 4 32 32 676

www.gulf-hra.com

1410 Burlington TowerAl Abraj Street Business Bay, Dubai

Documents

GulfHRA company profile · Master Transcription Coding/ CDMP Charge Capture Late ... process control, outcome, return on investment, ... Amity Health LLC MSH International