Insurance Coding

Accurate Reimbursement depends on appropriate coding, thorough and timely documentation and knowledge regarding the payment system. Our experienced staff will help ensure complete and accurate reimbursement through Medical Coding assessments, workflow analysis.

Our Services in revenue cycle management includes

Medical Coding and Billing

The Billing Process

The Billing Process represents the heart – the most integral portion – of the entire revenue cycle management value chain. It greatly benefits from accurate data capture in the early stages of the Revenue Cycle Management.

Medical CODING

Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnoses and procedure codes are taken from medical record documentation, such as transcription of physician’s notes, laboratory and radiologic results, etc.

In the UAE, Health Authority of Abu Dhabi (HAAD) and Dubai Health Authority (DHA) have mandated the use of standardized medical codes as part of providers’ e-claim transactions.

Our coders exhibit competency in both inpatient and outpatient

  • CPT (Current Procedural Terminology) – for procedure codes
  • ICD-9 and ICD-10 (International Classification of Diseases) – for diagnostic codes
  • IR DRG (International Refined Diagnosis-Related Group) – for patient classification system
  • ICD-10-AM (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification) – for diagnostic codes; specifically applicable to the Saudi Arabian healthcare market

RESUBMISSIONMedical Coding

 Our Resubmission team comprises highly skilled multi-disciplinary professionals with extensive experience in administrative-, medical- and insurance-related processes. Their objective is to review remittance advises received from payers for any denials and apply the necessary corrections and medical justifications through the:

  • Complete analysis of factors that led to the non- or partial payment against submitted claims;
  • Re-process claims with necessary changes and justifications and submit to the payer for re-evaluation;
  • Review the price list and contract terms with payer if rejection is related to the same;
  • Complete review of medical documents and provide medical justification to payers for services claimed; and
  • Provide suggestions for corrective steps to be implemented to reduce rejection rates.

RECONCILIATION

Reconciliation is an accounting process that uses two sets of records to ensure figures are correct and in agreement. It confirms whether the money leaving an account matches the amount that’s been spent, ensuring the two are balanced at the end of the recording period. The reconciliation process entails:

  • Performing claims analyzing for identifying reasons for rejection;
  • Verification, validation and assessment of claims eligibility for re-consideration post resubmission;
  • Ensure to maintaining the lowest rejection rate.

 

Health Authority Sites.

HAAD

DHA