Wednesday 11 December 2019
 
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Pulse Holding initiatives to cut healthcare costs

DUBAI, 22 days ago

Pulse Holding, a UAE-home grown holding company for several healthcare brands, has launched two initiatives to enable healthcare providers (HCPs) to plug revenue losses and redirect a healthy flow of investment to the sector.

The company has announced the launch of Santechture, an innovative company, and Knwbility, a knowledge transfer solutions’ network for revenue cycle management (RCM) aimed at preventing revenue leakage for HCPs.

RCM is the financial process used by hospitals and clinics to submit their patients’ insurance claim forms to insurance companies to request reimbursement of the services provided to patients. HCPs work closely with insurance companies to ensure patients get the best available treatment for their conditions.

However, to claim the amount for the service provided to patients, HCPs are required to file the diagnosed condition and medical, surgical, or diagnostic procedure conducted along with the respective medical codes and the total amount. With different international coding systems, comprising each around 80,000 codes for various diagnoses and procedures, the accuracy of the codes provided in insurance claims is prone to human error and complexity.

As a result, insurance companies deny or reject numerous submitted claims, and providers have to bear the costs for the services offered to patients.

Dr Ayham Refaat, founder and managing partner at Pulse Holding said: “Having been engaged with payers and providers for over fifteen years, we see that there is a gap in compliance, trust and understanding between both stakeholders.”

“We are uniquely positioned to understand the need to address rising healthcare costs and strengthen the relations between HCPs and payers to shape the healthcare sector into a more sustainable and trustworthy industry. HCPs have a valuable opportunity to rectify their incompliance with insurance companies’ coding systems and plug revenue losses.

“Our objective is to help them improve their revenue integrity and compliance with insurance companies by driving protocol-based healthcare methods and accurate and compliant reporting and billing, ultimately leading to more accurate diagnoses and a trust-based relationship between patients, insurance firms and HCPs. This creates a win-win situation for every stakeholder in the industry.”

Santechture is a company that has developed a number of technology solutions, including a software-based verification system, which can be embedded within all or specific stages of the RCM journey. The technology is able to identify the integrity of claims before being submitted to insurance companies, enabling HCPs to provide better diagnoses and reduce revenue losses due to inaccurate coding.

Anas Batikhi, vice president of Technology at Santechture said: “Santechture is an exciting state of the art technology for HCPs that will transform the RCM process and system. Santechture allows HCPs to keep the billing process internal, without feeling the need to outsource it, whilst increasing efficiencies, quality of documentation and creating a more sustainable ecosystem for them. It helps improving their revenue integrity and plugging their revenue losses caused by inaccurate billing.

“To bring this in context, healthcare spending in the wider Mena is expected to reach $144 billion by 2023. Imagine HCPs losing 15 per cent to more than a third of this revenue, which alternatively could have been used towards maintaining key services, such as highly specialised oncology consultants or investment into cutting edge equipment.”

Ayman Ibrahim, senior director for Knwbility Academy said: “Knwbility provides certification in the UAE and wider region for clinical and coding staff to hone the knowledge and expertise, in an easy-to-access online training course, of the various international coding systems used by insurers and regulators in the local markets.

“Our expertise in the sector has given us the ability to formulate a bespoke course in billing that can empower 80 per cent of the skills required for a coder to become well-versed with local billing protocols. We estimate that in the next decade, there will be a huge demand for medical coders in the GCC, with Oman and Saudi Arabia alone requiring 22,500 coders. Knwbility plans to meet 90 per cent of this demand and support the realisation of the national agendas of governments in the region that are committed to developing human talent.” – TradeArabia News Service




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