Gulf FZ L.L.C.

Revenue Cycle ManagementGlobeMed Gulf FZ

01. GlobeMed Gulf FZ at a glance

02. Improving your profitability and efficiency

03. Served programs

04. Revenue Cycle Management (RCM) solutions and services

- Eligibility and benefits verification

- Medical coding

- Medical necessity

- Charge capture

- Claims submission

- Denial management

- Accounts receivables follow-up

- Accounts reconciliation

- Reporting

- Extended business office services

- Call center

05. RCM solution platform

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01. GlobeMed Gulf FZ at a glance

Based in Dubai and incorporated in 2008, GlobeMed Gulf FZ-LLC provides Revenue Cycle

Management (RCM) solutions and services to healthcare providers. The organization helps

large, medium, and small hospitals and clinics in managing the entire lifecycle of claims,

payments, and reconciliation of accounts. GlobeMed Gulf FZ employs a state-of-the-art

technology platform and industry know-how and best practices to manage revenue cycle,

automating most of the processes and ultimately securing better cost containment and

enhanced performance.

GlobeMed Gulf FZ-LLC is a subsidiary of GlobeMed Group, the largest healthcare

benefits management company in the Middle East with over 25 years of experience.

The company has also emerged as system vendor providing business-transforming

solutions to healthcare stakeholders. It has 14 franchisees and licensees spread across

14 countries, servicing over 100 clients with over 5 million cardholders benefitting from

access to its automated cross-border network of healthcare providers.

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02. Improving hospitals and clinics’ profitability and efficiency

Healthcare providers are now faced with increased challenges varying from changing

regulatory requirements, to rising pressure to reduce costs, and the complexity of

managing multiple payers and different insurance plans.

GlobeMed understands your challenges and is uniquely positioned to assist you in

overcoming them. Our RCM solution helps you improve your profitability and efficiency.

For instance, we focus on optimizing your revenue capture and collection thus increasing

cash flow while meeting all regulatory requirements. You can rely on us for an improved

overall financial performance while you focus on what you do best in delivering great

patient care.

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04. Revenue cycle management solutions and services for healthcare providers

GlobeMed Gulf FZ offers a complete revenue cycle management solution for hospitals

and clinics. This includes determining patient’s eligibility, collecting their co-payments,

coding claims correctly, submitting and tracking claims, following up on pending claims

and account receivables, managing denials, and reconciling accounts. Furthermore,

we provide you with the necessary tools to better assist you in your decision making

process, along with reporting capabilities to help you evaluate your performance.

Our offering is based on system licensing with Business Process Outsourcing (BPO)

services which combines the advanced IT system along with our managed services.

We can provide you with front and back office services covering all functions under

revenue cycle, and tailored to cater to your specific needs. Furthermore, our system

allows seamless integration with hospitals and clinics’ information and billing systems

thus optimizing end-to-end automation and increasing efficiency.

03. Served programs

We manage medical claims related to a variety

of insurance programs including:

• Health insurance

• Motor insurance

• Workmen compensation insurance

• Travel insurance

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GlobeMed Gulf FZ manages the revenue cycle of the Ministry of Health’ wide healthcare provider network in the UAE, serving 16 major hospitals and 67 medical centers.

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Revenue Cycle Management Components:

RCMCOMPONENTS

* System driven

*Eligibilityand

BenefitsVerification

*Medical Coding

*Medical Necessity

*Charge Capture

*Claims Submission

Denial Management

A/RFollow-up

Accounts Recon-ciliation

*Reporting

Extended Business Office

Services

Call Center

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Real-time Eligibility and Benefits Verification

• Enhanced patients’ experience by: » Minimizing their

waiting period at your facility

» Offering better comprehension of their insurance coverage and their financial liabilities

GlobeMed helps you to streamline and automate communication with third party payers. Our application offers two approaches for you to manage patients’ eligibility and benefits verification. It is achieved by either giving third party payers a direct access to GlobeMed online portal or by integrating GlobeMed IT system with theirs so that they will be able to respond electronically to your eligibility and pre-authorization requests.

Using the GlobeMed portal you will be able to instantly verify the patient’s eligibility and scheme coverage entitlement prior to rendering services thus resulting in fewer denials or rejections from third party payers. Furthermore, patients will have less waiting time and will better understand their insurance coverage along with their personal financial liability such as applicable copayments, co-insurance, deductible amounts, etc.

Our medical coding solution will help you improve the accuracy of medical coding, thus ultimately reducing denials, improving the quality of data, and achieving high quality reporting.

In fact, GlobeMed’s coding edits engine is a tool that performs several code checks to control improper and incorrect coding which will otherwise lead to inaccurate billing and inappropriate payment.

It is designed to provide immediate feedback about potential errors, and alert the users in the different stages of the claims and revenue cycle management through several checks. This tool can also be run on data extracts/reports for coding review and correction before sending to payers or collectors.

Medical Coding

GlobeMed automated coding edits dictionaries are based on coding conventions and official guidelines, covering different classifications including American, Australian and WHO. It examines records and analyses disease and intervention codes:

• In combination with other codes and/or• In a sequence and/or• For their presence or absence and/or• For their specificity

To detect the following:

DuplicationChecks if disease and intervention codes are assigned more than once.

SpecificityDetects if diseases codes lack specificity by using ‘unspecified’ and ‘other specified’ diagnoses codes.

SequencingChecks if diseases codes are incorrectly sequenced such as unacceptable principal diagnosis / procedure.

BundlingDetects if a procedure code is reported with other procedure codes that are components, or part of the descriptor of the first code, or included in the first code for well-identified reasons.

Mutually exclusive procedureChecks if mutually exclusive codes are assigned together in the same encounter when it is unreasonable to expect services to be performed at a single patient encounter.

FrequencyDetects if a service code daily allowed frequency has been exceeded.

MismatchingChecks if procedure codes are mismatching with other procedures codes for well-identified reasons, such as sequential procedures, misuse or inappropriate methodology for code submission as identified in the coding guidelines.

Add-on codingChecks if add-on codes are sequenced as principle diagnosis and are not reported with related primary codes.

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Moreover, the system has a smart drop down selection feature facilitating the appropriate diseases and procedures codes selection.

You can also benefit from our coding services offering a cutting-edge coding training program to your staff or providing you with outsourced medical coding services through our team of certified coding trainers by the American Academy of Professional coders (AAPC) and the Health Information Management Association of Australia (HIMAA).

We have an extensive experience in coding the following classifications:

• ICD-9-CM• ICD-10• ICD-10-AM• ACHI• ICD-O (International Classification of

Diseases for Oncology)• CPT-4• HCPCS, level II• ICD-10-CM• ATC• Other local nomenclatures and

classifications

We provide coding for inpatient, outpatient, emergency, diagnostics, and other specialty coding.

• Automated detection of improper coding through advanced coding edit tools

• Improved quality of data and reduced denials

• A top notch Coding Training Program tailored to cater to your specific needs

• Outsourced reliable coding services

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Charge Capture• Online capture of financial terms with payers

• Automated pricing capabilities for all indicated procedures

• System supports: » Multiple pricing

schedules » Various pricing

structures (fee for service, lump sum and DRG)

GlobeMed’s application allows you to manage

various financial agreements with your

third party payers including assigned tariffs,

discounts, payment terms, and other contractual

obligations.

Our system has automated pricing capabilities

for all indicated procedures.

Medical NecessityAutomated medical necessity check and compliance through ARC - an advanced rules engine

"Medical Necessity" or “Clinical Medical Necessity” is defined as healthcare services that a physician, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing or treatment, injury, disease or its symptoms. Meeting medical necessity requirements is essential for the successful financial reimbursement from payers.

GlobeMed’ rules engine system, ARC, uses medical rules and coding edits to review procedure and diagnosis codes in place; it detects the performed procedure compatibility with the patient’s diagnosis as mentioned in the medical report, ensuring that all performed procedures relating to a certain diagnosis code are considered medically necessary.

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Claims Submission

Denial Management

Using GlobeMed online portal, you can

electronically submit medical bills and claims

for the rendering of medical services to third

party payers or to central e-claims hubs where

mandated by regulators,

Claims details include coding disease and

procedure, billed amount, third party payer share,

collected amounts from patients, etc.

Electronic submission of medical bills

• Optimizing the recovery and revenue

• System identification of underpaid and denied claims

• Automated claims resubmission

• Determining root causes and possible trends

GlobeMed’s system flags both underpaid

and denied claims resulting from conflicting

interpretations of clinical documentation,

incomplete or inaccurate information,

inconsistencies with third party payer policy,

and other reasons. Afterwards, appeal letters

and supporting documents are prepared and

communicated with corresponding third party

payers. We manage a timely follow-up on these

claims. Furthermore, we assess and analyze

rejected claims to determine any trends and

root causes to help you avoid future denied or

underpaid claims.

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Accounts Receivable Follow-up

Reconciliation

• Tools to highlight aging accounts

• Prompt follow-up on Accounts Receivable

We help you accelerate cash flow by resolving

outstanding accounts receivable.

GlobeMed’s system provides you with the

reporting tool to identify aging accounts. We

can also help you manage prompt follow-up

with third party payers to decrease amounts

and days in A/R.

Accounts reconciliation is an imperative

financial control measure. Bearing that in mind,

we ensure a timely reconciliation process

between third party payers and healthcare

providers’ accounts.

We keep, maintain and update accounts after

each financial transaction, capturing what was

billed by the healthcare provider and what was

paid by third party payers while taking into

account the agreed contractual terms.

Timely reconciliation between payers and healthcare providers’ accounts

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Reporting Capabilities

A variety of reports can be generated from the

system to help you monitor and follow-up on

different steps of the revenue cycle including

claims overview, bordereaux such as paid

invoices, aging amounts, and many other

detailed reports.

A set of reports to monitor the overall revenue cycle management

Extended Business Office ServicesOutsourcing of experienced and trained talents to support healthcare providers

Our extended business office services

provide you with the expert human resources

you need in different areas including medical

coding, prior-approval, claims submission

and billing, denial management and other

business aspects.

We use the industry best practices in applying

processes and workflows along with highly

trained professionals and advanced technology

to cater to your needs.

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Call Centers 24/7 call centers handling inquiries and complaints

Staffed with experienced and trained

professionals, our 24/7 call centers handle all

payers’ inquiries and complaints in cooperation

with the concerned internal hospital divisions.

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05. RCM Solution Platform

A Scalable IT System

GlobeMed system comprises a comprehensive set of fully integrated portals and

applications that are rules-driven.

Our RCM solution platform:

• Comprises a set of adaptable portals and applications • Offers multi-lingual and multi-currency options• Accommodates a diversity of business models and processes • Allows seamless and real-time integration channels with other

systems• Provides transparency to third party payers on claims activities and

settlements • Is supported by “ARC”, an advanced rules engine to detect and

flag improper selection of medical coding and unjustified medical necessity cases

The system runs an open architecture solution; all core modules are equipped with web

services that allow seamless and real-time integration channels with other systems

thus avoiding double data entry and data synchronization issues.

The scalable and modular architecture is optimized to deliver high performance for

accommodating and meeting current and future business demands.

Furthermore, we deliver a comprehensive remote and on-the-spot training on portals

for your staff along with sets of user guides and manuals, a valuable know-how

transfer tool.

Office 503, 5th Floor, AL Baker Bldg. 26Dubai Healthcare City, P.O.Box 505102

Dubai, United Arab Emirates

T +971 4 509 85 72F +971 4 429 85 71

www.globemedgulffz.com

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