Clinical coding is critical for public health reporting. It helps in the assessment of the quality of care, leading to improved health services planning, education, research, and performance monitoring.
The widely used code set for diagnoses is the International Classification of Diseases (ICD), of which the latest implemented version is the 10th edition (ICD-10). The code sets currently used in the Kingdom of Saudi Arabia are ICD-10-AM (Australian modification) for diagnosis reporting in all healthcare settings and the Australian Classification of Health Interventions (ACHI) for inpatient procedure reporting.
A comprehensive team of experts from ACCUMED Practice Management and the American Health Information Management Association (AHIMA), came together to develop the Kingdom of Saudi Arabia Billing System (KBS) in response to the requirements and compliance by the regulator that led to the development of this program.
This Outpatient Coder Certificate Program focuses on training healthcare professionals for coding in the ambulatory setting using ICD-10-AM and the Saudi Billing System (SBS).
Program Overview
The Outpatient Coder Certificate Program consists of total 12 modules beginning with an introduction to each of the classifications of the Saudi Billing System (SBS). then moving on to specialty-specific coding, and culminating with a practicum involving application of codes to ambulatory cases.
Those who successfully complete all 12 modules in addition to fulfilling the pre-requisite requirements of other three courses; are eligible to take the Outpatient Coder Certificate exam, administered by AHIMA.
Program Objectives
By the end of this certificate program, you will be able to:
Identify the structure and organization of the International Statistical Classification of Diseases and Related Health Problems – Tenth Revision – Australian Modification (ICD-10-AM), Saudi Billing System (SBS)
Apply the conventions and instructions found in ICD-10-AM, SBS
Determine diagnosis and procedure codes for ambulatory cases
Program Learning Outcomes
Top 5 learning outcomes you will achieve by attending this program
Successfully demonstrate the important role of the coding profession within the healthcare delivery system
Evaluate the compliance of health record content within the health organization
Determine diagnosis and procedure codes according to official coding guidelines
Adhere to workplace policies, procedures, and professional requirements
Ensure compliance with KSA regulatory requirements
Clinical documentation is at the core of every patient encounter. This documentation must be clear, consistent, complete, reliable, timely, and legible to accurately reflect the patient’s disease burden and scope of services provided.
The purpose of Clinical documentation integrity (CDI) programs facilitates the accurate representation of a patient’s clinical status that translates into coded data. Coded data is then translated into quality reporting, physician report cards, reimbursement, public health data, disease tracking and trending, and medical research.
The convergence of clinical care, documentation, and coding processes is critical to appropriate reimbursement, accurate quality scores, and informed decision-making to support high-quality patient care. Hence; CDI has a direct impact on patient care by providing information to all members of the care team.
CDI Program Objectives
The goal of clinical documentation improvement is accuracy, clinical soundness and final coding of a record after the discharge and helps to:
Improve quality of care by correctly capturing the patient SOI, ROM and ALOS, so that the hospitals can report the appropriate level of care
Standardize medical data for research and track analysis (W.H.O)
Augment the case mix index of the hospitals
Minimize claims rejections by the insurance
Apply suitable hospitals reimbursements for the level of care they provide
Maximize the DRG assignment and optimize payments for the services rendered to the patient
Learning Objectives
By attending the CDI courses; you should be able to:
Understand the importance of Clinical Documentation improvement and the Diagnosis Specificity impact on the patient quality care
Manage the coding and diagnostic elements that should be identified to support high quality clinical documentation and coding
Differentiate between clinical vs diagnostic terms
Identify common ICD-10-AM Documentation Requirements for the procedures
Pin-point the common severity drivers for effective treatment and results
Fundamentals of Healthcare Revenue Cycle Management is an online course to help you understand the basics of healthcare RCM. It navigates the learner from “What is RCM to Healthcare RCM, global trends and best practice to regional insights and the scope of CDI (Clinical Documentation Improvement) in RCM.
This course provides a complete overview of different departments or units of RCM and the RCM process flow from patient registration to end billing. This modular course covers RCM learning from an international perspective and is not confined to any one country standards. We have included various roles of RCM in our course; that serve as a source of knowledge and also helps you identify a suitable RCM model for improved revenues and financial outcomes.
This course will benefit
Healthcare professionals keen to understand the Revenue Cycle Management; including but not limited to:
Physicians
Nurses, allied health professionals
Administrative and billing professionals
Managers, team leaders, supervisors and heads from insurance and coding departments
Senior executives who are keen to gain a macro-overview and understanding of RCM function
Course Objectives
By the end of the entire course; you will be able to:
Comprehend different versions of codes available in any RCM practice and recognize the differences in various versions of coding in respect to the country’s Healthcare Billing System
Gain 360 degrees understanding of RCM concepts and principles ranging from coding to insurance protocols to billing regulations and compliance; in addition to claim submissions, insurance denials, and reconciliations
Become aware of Revenue Cycle Management (RCM) concepts to maximize the billing potential leading to increased revenues and improved financial results
Like all health-related clinical classifications, the ICD-10-AM, ACHI and ACS classification system is not a static system. Significant changes are made every two years in Australia to maintain clinical relevancy, resulting in national edition changes.
Regular updates are introduced in between edition change in response to evolving health and data requirements. These changes can respond to the World Health Organisation introduction of new codes or release of emergency use codes to capture new diseases or areas of global concern (pandemic). An example is the outbreak in December 2019 of a new coronavirus CoV2 or CoVID-19.
Other guidelines that may highlight changes to coding practice issued over the lifecycle of ICD-10-AM that, while not part of the current classification edition, are essential to understand and standardizing coding practice.
These guidelines are issued by and undergo continuous review by the Independent Pricing Authority of Australia (IHPA), authorised to develop and maintain the ICD-10-AM, ACHI and ACS.
Many guidelines are incorporated in the classification through each edition change from 6th through to 10th edition but there a still many that have been reviewed and still considered current essential information for clinical coders using ICD-10-AM.
After completing the ICD-10-AM, ACHI and ACS 6th edition upskill to 10th edition course, clinical coders will have the necessary knowledge to identify and apply the changes in the classification to code inpatients using the ICD-10-AM, ACHI and ACS 10th edition as mandated (Saudi Health Council), 1 January 2020 as well as the necessary skill to apply current guidelines in daily practice.
Learning Objectives
By the end of the course, you will be able to:
Identify new, major and significant changes to the coding standards between the 6th and 10th editions
Understand how the classification changes between 6th and 10th editions impact current coding practice
Recognize the appropriate level of detail of clinical data required to meet the change
Evaluate the relevance of other health conditions and factors affecting the patient to establish principal and additional diagnoses
Apply general and specialist specific clinical standards to support clinical coding
Discover any Kingdom of Saudi Arabia national coding standards and regulations where appropriate to ensure correct assignment of inpatient codes
The Australian Refined Diagnosis Related Grouping (AR-DRGs) course, designed for the healthcare professional looking to understand the AR-DRG and its role in healthcare data and reimbursement. The content covers essential information to:
Explore the evolution of the DRGs from their historical roots through to AR-DRG V9.0 (as used in KSA)
Discuss key concepts of data collection and methodologies, including the role of quality documentation, clinical coding and DRG allocation through comparative cases studies
Evaluate different healthcare funding models with particular attention to Accountable Care Organisations, healthcare financing reforms and the road to Value-based healthcare
Introduce continuous analysis activities and audit programs to support the transformation
This course will benefit
Professionals from Healthcare and Insurance Institutions Including:
Managers of coding, Quality, Finance, Revenue Cycle Management (RCM)/li>
Business Intelligence staff
Administrative and billing professionals
Clinicians with interest in healthcare financing and Value-Based Healthcare
Clinical Documentation Improvement staff and clinical coders
Learning Objectives
By the end of the entire course; you will be able to:
Explain the AR-DRG and its role in healthcare by understanding the sources of information required to identify the appropriate AR DRGs
Identify the differences between nomenclatures, terminologies and classifications and explain their individual and collective value
Discuss the importance of clinical documentation and accurate clinical coding
Recognise the drivers of AR-DRGs and their impact on patient complexity levels
Define and use appropriate terminology associated with AR-DRGs in an ABF/M funding environment
Benefit from the value of DRGs in an insurance funding model
Gain the knowledge of implementing continuous analysis and audit
