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Certification Training - Medical Coders, Billers Auditors

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Certification Training - Medical Coders, Billers Auditors

RCM Certifications

Need for CHRP –

  • To understand the basic terminologies in Medical Billing, steps involved in a claim cycle, all that is required to submit a claim.
  • It helps in understanding the basic difference between the process handled in Abu Dhabi and Dubai in a claim cycle
  • It educates on the various methods of Insurance Payment Methods both Medical & Dental with Respect to Abu Dhabi and Dubai.
  • Explains in detail the various billing adjudication rules of each Section of CPT as per the regulators (DOH/ DHA).
  • To introduce the learner to the world of codes which is used to interpret various diseases and procedures.
  • To educate about the navigation of CPT 4, ICD 10 CM, HCPCS codes and how to decide on Principal and Secondary diagnosis.
  • In detail the different methods of Submissions in Abu Dhabi (Shafafiya) and Dubai (eClaim).
  • Based on Insurance denials, how to analyze and decide on Resubmission. To identify when a claim should be moved to Reconciliation.
  • The violations standards of DHA & DOH and application of compliance rules to different Specialties

Eligibility – Any Bachelor’s / Master’s degree approved by the respective country
Contents –
Introduction
Module 1 – Introduction of RCM
Module 2 – Coding Concepts
Module 3 – Insurance Protocols
Module 4 – Billing Regulations & Compliance
Module 5 – RCM Operations (Submissions, Denials, Re submissions, Reconciliations)

Need for CHRS –

  • To revise and to have an overall understanding of the RCM Audit Process.
  • To redefine career as an Auditor in RCM Healthcare.

Eligibility - Any Master’s degree approved by the respective country or must have completed CHRP or have minimum 2 years experience in RCM healthcare in UAE or any country. With qualifying an aptitude test.

Contents –
Module (1 - 5) - Refer 5 Modules of CHRP
Module 6 - Audit Methodologies / Medical Records / Compliance/ Risk Assessment
Module 7 - Jawda indicators & Audit Tools

Need for CHRE –

  • To shift from one vertical to another being a Manager.
  • To get oriented with various functions or verticals of RCM if from another vertical.
  • To launch a career as an Executive – either a Manager or any equivalent state.

Eligibility – Any Master’s degree / CHRP course + 3 years of RCM experience or one who Completed CHRS Course + 2 years of experience or minimum 5 years of RCM experience.

Contents -
  • Modules 1- 5 of CHRP
  • Modules 6,7 of CHRS
  • Module 8- Stabilization & Sustaining Revenue in the Organization – Methods/ Obstacles with Case studies.
  • Module 9 - Leadership in RCM /Attributes (Soft Skills) of an efficient Manage


ICD 10 AM

Need for ICD 10 AM –

  • Job Opportunity for a fresher in the respective Nation or a migrant looking for a job abroad in ICD 10AM practicing countries.
  • To gain knowledge on ICD 10 AM for proper claim submission by a current coder
  • To add a feather to the cap as certification for a coder of any nation.

Eligibility –
  • Fresher looking for a job
  • Coder who wishes to migrate
  • Need for a Coding Certification


Content –

CC1 - Introductory course consists of Clinical Coding for the following subjects:
  • Endoscopy
  • Oncology
  • Accidents and incidents
  • Endocrine
  • Ophthalmology and ENT
  • Digestive (including dental)
  • Urinary and male reproductive
  • Gynaecology
  • Bones muscles skin and nerves
  • Cardiovascular

  • Psychiatry
  • Infectious
  • Respiratory
  • Oncology haematology and immunology
  • Accidents and incidents
  • Endocrine
  • Digestive
  • Genitourinary
  • Gynaecology
  • Bones muscles skin and nerves
  • Cardiovascular
  • Obstetrics
  • Paediatrics

To get educated on ICD 10AM analyzing the differences between CM and AM. To convert CM certification to AM one.
Eligibility-
CPC / CCS/ CPMA or any equivalent Coding Certification

Need for Conversion Course -

  • To get Certified in ICD 10 AM/ ACHI/ ACS.
  • To gain a suitable job in Hospitals and Clinics using ICD 10AM

CPC / CCS/ CPMA or any equivalent Coding Certification Content- Conversion from CM to AM +Intermediate Course (CC2)
1. Conversion Course (CM to AM) Topics
  • Introduction to AM, ACHI &Clinical Documentation for AM
  • Coding Essentials
  • Digestive
  • Endocrinology
  • Oncology, Haematology, Infections
  • Cardiovascular
  • Psychiatry
  • Obstetrics & Gynecology
  • Injury, Poisoning & External Causes
  • Other Specified Standards
  • Paediatrics

2. Intermediate Course – CC2 Topics-
  • Psychiatry
  • Infectious
  • Respiratory
  • Oncology, Haematology & immunology
  • Accidents and incidents
  • Endocrine
  • Digestive
  • Genitourinary
  • Non acute care
  • Bones muscles and nerves
  • Cardiovascular - Heart
  • Obstetrics
  • Paediatrics
  • Neurology
  • Vascular 



ICD 11

Need –
To educate nations adopting a new Healthcare System
To participate in the mission of WHO in introducing a new Coding System

Eligibility-
Job Seekers, Experienced Coders who would want to update their Coding Knowledge
Coders of the Country where ICD 11 is decided to be implemented.

Contents- ICD 11/ ICHI/ ICF
ICHI-

  • 1 - Interventions on Body Systems and Functions
  • 2 - Interventions on Activities and Participation Domains
  • 3 - Interventions on the Environment
  • 4 - Interventions on Health-related Behavior
ICD 11 Topics-
  • Certain infectious or parasitic diseases
  • Neoplasms
  • Diseases of the blood or blood-forming organs
  • Diseases of the immune system
  • Endocrine, nutritional or metabolic diseases
  • Mental, behavioral or neurodevelopmental disorders
  • Sleep-wake disorders
  • Diseases of the nervous system
  • Diseases of the visual system
  • Diseases of the ear or mastoid process
  • Diseases of the circulatory system
  • Diseases of the respiratory system
  • Diseases of the digestive system
  • Diseases of the skin
  • Diseases of the musculoskeletal system or connective tissue
  • Diseases of the genitourinary system
  • Conditions related to sexual health
  • Pregnancy, childbirth or the puerperium
  • Certain conditions originating in the perinatal period
  • Developmental anomalies
  • Symptoms, signs or clinical findings, not elsewhere classified
  • Injury, poisoning or certain other consequences of external causes
  • External causes of morbidity or mortality
  • Factors influencing health status or contact with health services
  • Codes for special purposes
  • Supplementary Chapter Traditional Medicine Conditions - Module I
    • V Supplementary section for functioning assessment
    • X Extension Codes
ICF –
  • Musculoskeletal Conditions
  • Neurological Conditions
  • Mental Health
  • Other Health Conditions
  • Diverse Situations
  • Cardiovascular & Respiratory Conditions
  • Cancer



Medical Coding Auditing

Need –

  • To become a RCM Healthcare Auditor in UAE
  • To learn the various Auditing methods across the Nation
  • To efficiently apply Auditing techniques based on Regulatory guidelines and Coding Guidelines
Eligibility –
  • Any one interested in becoming an Auditor with minimum 2 years of experience in any vertical of RCM.
Contents –
  • Compliance & Regulatory Guidelines
  • Medical Record Standards & Documentation Guidelines
  • EM Coding Guidelines +DSL codes
  • Coding & Reimbursement
  • Audit, Scope & Statistical Sampling Methods
  • Risk Analysis & Communication
  • Case Studies