Strategic Revenue Cycle Management In The UAE

The Strategic Revenue Cycle Management in the UAE course provides a comprehensive overview of the healthcare insurance system in the UAE, including the coding and billing regulations from the UAE’s Department of Health (DOH) and the Dubai Health Authority (DHA). It focuses on the critical aspects of revenue cycle management (RCM), from claim submissions to insurance denials, resubmissions, reconciliation, and billing compliance. This course ensures that participants gain practical knowledge on the processes that ensure accurate medical billing and reimbursement.

The course delves into how claims are generated following a patient visit, how these claims move through the billing cycle, and how to resolve issues that may arise, such as claim denials or inaccuracies. It emphasizes the importance of accurate documentation and the management of the information required to avoid common pitfalls in the claims process.

Clinical Documentation Integrity Course
Categories
UAE

Course Overview

This course is designed for healthcare professionals looking to understand the full spectrum of Revenue Cycle Management in the UAE. It equips participants with the knowledge needed to navigate the UAE’s complex healthcare insurance system, including coding standards, billing rules, and compliance protocols. The course also covers how effective claim management can ensure proper reimbursement and address any challenges related to denials and reconciliation. Key topics include the UAE’s healthcare insurance programs, the regulatory requirements from DHA and DOH, the role of DRG in billing, and how clinical documentation impacts revenue cycle management. Participants will also explore case studies to understand real-world applications of these concepts, ensuring they are prepared to handle the complexities of medical billing in the UAE.

Objectives

By the end of this program, participants will:

  • Demonstrate proficiency in understanding the various insurance programs offered by each Emirate, including those for Emiratis, government employees, and expatriates.
  • Explain the coding and billing adjudication rules as per the DHA (Dubai Health Authority) and DOH (Department of Health).
  • Identify and apply the different methods of billing for medical and dental procedures practiced in Dubai.
  • Understand and articulate the role of DRG (Diagnosis-Related Group) in billing, and its importance in current billing processes.
  • Ensure adherence to compliance standards for Outpatient and Inpatient records according to UAE regulations.

Learning Outcomes

Participants will be able to:

  • Proficiently navigate and apply the various insurance programs for Emiratis, government employees, and expatriates across the UAE.
  • Accurately interpret and implement the coding and billing adjudication rules as per DHA and DOH guidelines.
  • Effectively identify and apply billing methods for medical and dental procedures practiced in Dubai.
  • Demonstrate a clear understanding of the role and importance of DRGs (Diagnosis-Related Groups) in billing and their impact on the billing process.
  • Ensure compliance with UAE standards for both Outpatient and Inpatient records and billing practices.

Curriculum

Program Modules

Module Number Module Title Duration Description
Module 1 Insurance Protocols 2.5 hours A guide to understand medical billing terminologies, steps in the claim cycle, roles of various teams, and differences in claim processes between Abu Dhabi and Dubai.
Module 2 DHA Coding, Billing Rules and Dental Coding Guidelines 2.5 hours Covers DHA billing rules, coding rules, and insurance payment methods for both medical and dental procedures in Dubai.
Module 3 Billing Regulations – DOH 2.5 hours Explains DOH billing standards for Abu Dhabi, with detailed coverage of CPT sections and insurance payment methods for both medical and dental procedures in Abu Dhabi.
Module 4 UAE Coding Concepts 1 hour Introduces coding concepts (ICD-10 CM, CPT, HCPCS), including guidance for determining principal and secondary diagnoses and accurate coding for uncertain diagnoses.
Module 5 Claim Submissions 2.5 hours Explains submission methods in Abu Dhabi (Shafafiya) and Dubai (eClaim), and provides knowledge on claim form portals, ideal prescriptions, claim denials, and denial codes.
Module 6 Insurance Denials, Resubmissions, and Reconciliations 1.5 hours Focuses on denial codes for DOH and DHA, methods to identify denial reasons, and strategies for resubmissions and reconciliation.
Module 7 Billing Compliance 1.5 hours Covers regulatory compliance, DHA and DOH standards, and applying compliance rules across different specialties to ensure a practice remains compliant with regulations.

Module Features

  • Audiovisual lectures (face-to-face or online)
  • Practice coding scenarios with instructor feedback
  • Module assessments