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RCM Consultancy & Audit Services

Services
RCM Consultancy & Audit Services

Auditing service primary objective is to ensure an effective, efficient, and financially sustainable healthcare system. We comprehensively review capability of clinical data recording, medical coding, clinical documentation, compliance and evaluate the accuracy and completeness of submitted claims by identifying the impactful leakages and gaps in order to provide precise solutions in accordance to the UAE market needs and requirement.

 

Who needs audit services?

 

  • The healthcare providers for both Private and Public sectors within the UAE

 

When is audit service required?

 

  • The Auditing service is required all the time for the healthcare providers because it enables the providers identify the actual gaps happening within the organization which is needed to appropriately provide solutions for improvement.

 

Why audit is required?

 

  • It helps identify and correct errors areas before insurance or government payers challenge inappropriate coding
    Protect against fraudulent claims and billing activity
  • Increases Quality of healthcare
  • Increase potential of DRG and CMI Optimization
  • External (Non-Biased) Viewpoint
  • Reduction of Improper Practices and Payments

 

Methodology

Define Audit Objectives and Methodology
1. Signed NDA and Audit Notification
2. Gather Background Information for Assessment
3. Identify (Point of Contact)- POC

Gather evidence to accomplish audit objectives
1. Conduct Interview
2. Systems Orientation
3. Initiate Audit Review

Audit- Analysis
1. Gap Analysis
2. Audit Feedback and Reports Creation

Communicate Audit Results
1. Distribute Final Report to appropriate and required individuals
2. Discuss Findings, Solutions and Recommendations