The UAE’s healthcare costs are rising at a rate of about 13% yearly. Santechture, an innovative RCM software solution company, and Knwbility, a knowledge transfer solutions’ network for Revenue Cycle Management (RCM), have been launched by Pulse Holding, a UAE-based holding company for several healthcare brands. These initiatives will allow healthcare providers (HCPs) to plug revenue gaps and reroute a healthy flow of investment to the industry.

The financial procedure known as revenue cycle management is used by hospitals and clinics to send insurance claim forms for their patients to insurance companies in order to request payment for the patient services rendered. HCPs collaborate closely with insurance providers to guarantee that patients receive the best care possible for their conditions. HCPs must submit the diagnosed condition and any related medical, surgical, or diagnostic procedure along with the appropriate medical codes and the total amount in order to be reimbursed for the service provided to patients. The accuracy of the codes provided in insurance claims is subject to human error and complexity due to the numerous international coding systems, each of which contains roughly 80,000 codes for various diagnoses and procedures.

As a result, many submitted claims are denied or rejected by insurance companies, and providers are left to pay for the services they provide to patients. This translates into sizable revenue losses, which frequently puts pressure on providers to turn to non-protocol led treatment pathways that can carry unnecessary testing and investigation to recover lost revenues, or they can subject the patient to additional unnecessary diagnostics in an effort to be on the safe side and comply with payers’ protocols in order to secure payment. Providers with a high rate of denials are frequently dropped from insurance networks, which limits patients’ access to those providers.

Santechture and Knwbility are two solutions Pulse has introduced to address this issue. Pulse previously launched ACCUMED, the first and largest outsourced Revenue Cycle Management company in the region. After working with payers and providers for more than 15 years, Dr. Ayham Refaat, founder and managing partner of Pulse Holding, stated, “We see that there is a gap in compliance, trust, and understanding between both stakeholders. We are in a unique position to comprehend the need to address escalating healthcare costs and improve ties between HCPs and payors in order to reshape the healthcare industry into one that is more dependable and sustainable. HCPs have a great chance to stop violating the coding policies of insurance companies and stop losing revenue. By promoting protocol-based healthcare practices, accurate and compliant reporting, and billing, we hope to assist them in improving their revenue integrity and compliance with insurance companies, which will ultimately result in more accurate diagnoses and a relationship based on trust between patients, insurance companies, and HCPs. This results in a win-win situation for all industry stakeholders.”

Santechture has created a number of technological solutions, including a software-based verification system that can be integrated into all or only some stages of the RCM process. Before claims are submitted to insurance companies, the technology can evaluate their validity, allowing HCPs to make more accurate diagnoses and stop losing money because of incorrect coding.

“Santechture is an exciting state-of-the-art technology for HCPs that will transform the RCM process and system,” said Anas Batikhi,CEO at Santechture. Santechture increases efficiency, improves documentation quality, and fosters a more sustainable environment for HCPs by allowing them to keep the billing process internal without feeling the need to outsource it. It assists them in enhancing the integrity of their revenue and plugging revenue losses brought on by incorrect billing.To put this in perspective, it is anticipated that by 2023, healthcare spending in the wider Middle East and North Africa will total $144 billion. Imagine HCPs losing 15% to more than 30% of this revenue, which could have been invested in cutting-edge equipment or used to maintain essential services like highly specialized oncology consultants.

In the Media: Zawya