Managing Director Dr Mohammed Aldar outlines the role of Accumed in cementing its role in the future of healthcare
As healthcare grows as a global sector, revitalising itself through digital solutions and AI uptake, it’s vital that its revenues keep pace. Regulations and reimbursement models have been changing, so providers need to upgrade their own systems to ensure that they correctly bill patients and insurers for the care rendered.
For Dr Mohammed Aldar, the main goal of a company such as Accumed is to make sure that every claim is payable. To achieve this, accurate medical coding and invoicing is paramount, and Accumed handles everything related to the operations of health insurance and bill issuing, medical coding and ensuring that the medical documentation is justifying the medical necessity. This includes scheduling, patient registration & eligibility check, charge capture, preauthorisation, medical coding, collection and reconciliation in addition to the denial management.
There are many stakeholders involved in the process, from patients to payers, medical to administration stakeholders. “The main pillars are people, process and technology,” Mohammed says. “We need medical data, operational data and financial data to make it a success. It’s a very complex, comprehensive handling process, but if done correctly can reduce costs across whole healthcare systems.”
For the individual client, Accumed is not just any revenue cycle management company. By outsourcing billing functions, operational burdens related to human resources (i.e. staff salaries and benefits), office space, software licenses and upgrades – plus the headache of regulatory and payer compliance – are removed from the equation,” he says. “In this way clients can focus on offering qualitative patient care and accelerating cash flow, rather than engaging in daily billing and collection concerns.”
Having a cohesive structure in place improves time management, communication, regulatory compliance, and the ability to spot possible coding and billing oversight, allowing providers to maximise revenue cycle opportunities at point of care. “Our target is to increase client revenue as well as increase collection. So instead of having like high rejection rate from the insurance companies, we will try to optimise the RCM processes in order to get the maximum possible.”
RCM in the Middle East
In the Middle East, revenue cycle management or RCM remains at a nascent stage. However, its prospects are bright as the region’s healthcare market holds untapped potential. According to industry estimates, healthcare spending in the wider Middle East and North Africa (MENA) is expected to reach USD144 billion by 2020.
The Middle East healthcare market is also evolving with new regulations, laws, systems, processes and financial dynamics, making RCM a cornerstone in the healthcare industry. Accumed was one of the first companies to operate in the Middle East and now works in eight different countries including the UAE and Saudi Arabia. They also have alignments in in Australia as well as the United States. “We are actually perceived as the first, if not the best, revenue site in the Middle East,” Mohammed says.
The company began working in Saudi Arabia in 2020, one of the first companies licensed there. They have strategic partnerships with Johns Hopkins Aramco, an elite high end provider hospital, and King Faisal Specialist Hospital and Research Centre, along with several partnerships with the Ministry of Health.
With a population of around 36.8m, the Kingdom is a huge market. According to Mohammed, 11.8m people are insured and there are more than 5500 approved providers. There are 24 approved insurance companies and also third party administrators. The size of the insurance market is $16bn with a growth of 26 per cent between 2021 and 2022.
The health estimates formation deliverables for Vision 2030 align to a certain extent with Accumed’s pillars. The first is providing people-centred integrated healthcare; the second is achieving effective and sustainable financial resources management and the third is investing in private sector integration to create strategic partnership. Last but not least is employing digital and virtual health tools, so investment is important to allow optimum revenue collection to allow for a sustainable healthcare infrastructure system.
The role of RCM in value-based healthcare
Effective revenue collection management has greater relevance than a purely financial one. Providing the best service increases staff satisfaction, which then provides better service. This can be achieved at an administrative level by effective RCM systems, providing clarity to staff, reducing turnaround times and admin burdens.
Value-based health care consists of delivering the best outcomes of the health care solution or system at an effective cost. It reduces readmissions, delivering better patient outcomes and satisfied clients. But, according to Mohammed, you cannot build up your health care system without having the right tools for analytics. “If you don’t have the big data, you cannot set your strategy ahead,” he says. Clinical, financial and operational data are all required in order to come up with decisions. Data is also necessary to work out the standardisation of processes. Without it, price comparisons and benchmarking are impossible and value is difficult to establish.
The Saudi government has just approved convenience share models, which are basically RCM companies or any private sector companies in partnership with the government, based on a revenue share. For Mohammed, this is the future. “We are expediting digitalisation, optimising revenue and, like upselling and crossselling, opening up capacity through hybrid and blended solutions. Such activities build up the capacity within the governmental sector so that they don’t only outsource or request to outsource the RCN to us, but also enable us to take over the current manpower where we transmit the knowledge, so in 3 to 5 years’ time, they will be able to continue the journey on their own.”