HIMSS News

Healthcare in Saudi Arabia: Addressing revenue cycle management

Dhiraj SharmaAll citizens of Saudi Arabia are guaranteed healthcare under the country’s basic law. But an increase in population, life expectancy and sedentary lifestyles have led to a rise in demand for healthcare services, putting stress on the existing healthcare infrastructure.

Partly because of these forces, Saudi Arabia is embracing private health insurance for its citizens and expatriates to bring a sense of ownership to personal health and enhance the affordability of care.

Although government officials just recently started this process, they have already laid the groundwork for the new system, including advanced revenue cycle management. Several components will be crucial to the design of this capability and its integration with the existing system, which is operated by the Ministry of Health and delivers roughly two-thirds of health services in Saudi Arabia across more than 20 regions, 300 hospitals and 2,000 primary care centers.

  • Network & contract management: In order to tap into healthcare service networks, payers need contract management systems to help define coverage and secure reimbursement for providers. A comprehensive contract with a wide provider network can help ensure care coordination and cost containment.
  • Patient eligibility: Eligibility verification, with service details, lays the foundation for the billing process. This tells providers what they will get paid and thus what they should be charging.
  • Billing estimates: Billing operations play a major role in a practice’s sustainability. A close estimation with prior authorization reduces claims disputes, improving account receivables from payers and patients.
  • Claims management: Submission of claims by providers should be standardized as this helps with fraud and abuse detection and helps introduce care standardization and utilization management. Claims adjudication should provide clear service-level details to providers on each payment or rejection, with reason in alignment with active contract. Patients should also be able to view payment details, along with payment due to providers from them.
  • Technology as an enabler: Saudi Arabia is embracing the concept of health information exchange, an important step toward care continuity. With increasing penetration of electronic medical records (EMRs) and acceptability of standardization in clinical, eligibility, claim and payments; Saudi will be set to meet the global healthcare standards.

Revenue cycle management is evolving and is here to streamline not only service and payment processes, but also engage patients by making them accountable for their own health. As revenue cycle management matures, it will lead to introduction of value-based care, preventive health and wellness management as added benefits.

REFERENCES

  • Healthcare in Saudi Arabia, The Economist Intelligence Unit
  • Kingdom of Saudi Arabia: Healthcare Overview, Colliers International
  • The Future of Revenue Cycle: Preparing for Near-term Change, HIMSS Revenue Cycle Improvement Task Force, HIMSS (Healthcare Information and Management System Society)
  • Next Generation Patient Access, Whitepaper, HIMSS Revenue Cycle Improvement Task Force
  • Outsource or Build it Yourself?: Revenue Cycle Considerations for your Practice, Whitepaper, NueMD
  • The Future of Healthcare in Saudi Arabia, Prof. Manzour M. Al-Nouzha, College of Medicine, King Saud University, Riyadh

Dhiraj Sharma, manager for Accenture Health, has over 15 years of healthcare IT experience with payers and providers in the U.S., Europe and Asia Pacific. Mr. Sharma has built solutions like mHealth, patient remote monitoring and claims analytics. He’s worked in IT strategy, business process automation, program and account management.