Revenue management systems key to success of Saudi health reforms says KPMG

RIYADH: Robust revenue cycle management systems will be essential for Saudi Arabia’s new health care model, KPMG said in a report.
The Kingdom’s Ministry of Health (MoH) is transitioning from being an all-in-one payer, provider and regulator of health services to becoming a regulator, governing corporate payers and providers.
A key aspect of this transformation is the separation of the payer and the provider functions in the public health care sector, KPMG said. To facilitate future reimbursement to public health care providers, the Ministry of Health has set up the Program for Health Assurance and Purchasing (PHAP).
In addition, the Council of Cooperative Health Insurance (CCHI) has also firmed up regulations for private insurers.
With the introduction of mandatory health insurance underway in the public sector in the Kingdom and the wish to standardize across the public and private sector, Saudi health care providers will need to develop new capabilities to be able to generate revenue under the new reimbursement system, KPMG reported.  
“One of the key implications for health care providers of this introduction is the transformation of how health care service providers are reimbursed. Providers will primarily be paid on a per-patient basis, rather than via allocated budgets from the government,” said Emmeline Roodenburg, head of health care at KPMG in Saudi Arabia.
Patient acceptance and registration; billing and claims management; patient treatment and documentation; and coding and grouping are the four key operational elements of the Revenue Cycle Management (RCM) under the new mechanism.
While the risks that come with having a poor RCM function can be managed and mitigated, if they are left unchecked then the consequences could include revenue losses and fines for inaccurate invoicing, KPMG said.