The Challenge

As a major healthcare provider, the client had long-standing contracts and billing practices with payors across the UAE.

Multiple regulatory and operational updates had resulted in perceived inefficiencies in the Revenue Cycle and collection processes, emanating from legacy contracts,  the internal bifurcation of the operating model and separation of financial accounting practices.

Additionally, the strategic intent of the client was to move to a Value Based healthcare model required a fresh understanding of the RCM performance baseline.

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Our Approach

• Evaluated the current RCM models through multiple lenses, including review of processes and policies for Claim Submission, Resubmission and Reconciliation
• Benchmarked against international and regional practices
• Identified the capabilities needed to enable the RCM function to support VBHC models
• Engaged with client stakeholders to establish and prioritize improvement opportunities and initiate a roadmap framework for future RCM activitiesatient archetypes

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Outcomes

• A suite of prioritized recommendations to improve both the efficiency and effectiveness of RCM capabilities in the client (several since implemented)
• Quantified benefits (and opportunity costs) of effecting change
• A framework for developing recommendations into practical and early actions to realise change.