Dubai PR Network, Online Press Release from Dubai and Middle East
Trade & Commercial(Others)
Filter PR by
Need for consensus on best practices in medical care & costs

Government, healthcare providers and insurance companies should review ways to ensure that the delivery of quality healthcare services to patients is done based on cost-effective methods, says AccuMed PM

Dubai, UAE, June 20th, 2013: Different diagnostic procedures performed for similar medical conditions are leading to a significant amount of differences in the cost of medical insurance claims, a leading healthcare management company has pointed out.

AccuMed PM, a leading provider of innovative healthcare billing solutions, said the opportunity to understand trends through robust data analysis by key stakeholders, will improve patient experience, care and potentially save costs which in turn benefits all of us paying for insurance.

Pointing to an AccuMed PM case study that analyzed different procedures used to diagnose or rule out diabetes, hypertension, anemia, thyroid disorders and Vitamin D deficiency, Dr. Ayham Refaat, Founder and Managing Director of AccuMed PM, said that 0ver 8.6% of claims that were submitted were found to be disputable between the insurance companies and healthcare providers.

The study looked at 598,000 insurance claims amounting to approximately AED263 million, of which the disputed amount was AED20.4 million. The debatable amount reflects the inconsistencies in the number of tests performed and billed versus the ones paid for. As part of the same study, AccuMed analyzed further 25,844 cases of diabetes and found that the number of tests requested for the same diagnosis during the same visit ranged from 2 to 12 tests, with values ranging from AED 40.23 to AED 157.27 per case.

“The debate arises when there is no clarity on how healthcare providers choose different tests to diagnose the same condition and at the same time, it is not clear on what clinical basis insurance companies sometimes choose to pay for the test or reject it outright at other times, despite the fact that the diagnosis remained the same and only one,” Dr.  Refaat told a conference in Dubai today.

Dr Refaat, a leading authority on medical billing, said that the definition of medical necessity is a growing area of dispute between payers and providers. He called for comprehensive data mining and trending analysis that were aimed towards the establishment and deployment of UAE-friendly unified clinical pathways that will determine the guidelines for diagnosis and treatment of medical conditions.

Clinical care pathways are medical guidelines that are based on evidence-based practices in which the different tasks performed by the clinicians involved in the patient care are defined, optimized and sequenced. This multidisciplinary management tool is vital to manage the quality aspect of healthcare in relation to the standardization of care processes. Such standardization reduces the variability in clinical practice and improves quality as it illustrates a structured and effective care map based on evidence based practice

“Having a predominantly insurance-driven focus might affect the financial sustainability of the region's healthcare sector, leaving insurance companies and healthcare providers to grapple with the actual costs of healthcare services,” Dr Refaat said. “Unless proper mechanism was put in place, the costs of these undecided treatments can have major financial repercussions on the region's healthcare system, affecting healthcare providers, insurance companies and government regulators.”

“Such case studies are some of the many trending analysis that can improve our understanding on how to effectively manage the UAE's healthcare market. Studies such as claim cost-benefit analysis, activity-based costing and utilization ratios, to name a few, undertaken by AccuMed PM have helped physicians and insurance companies to make informed decisions on quality of care, profitability and operational efficiency accordingly,” he added.

Another major problem in the GCC was the poor understanding of best practices and international guidelines in medical coding. Medical coding is the process of assigning codes to a patient's medical diagnosis and procedure descriptions which should be performed by certified coders and only after reviewing the clinical notes of the physician. Collecting and reporting aggregate information through codes allows the medical community a simplified way to provide data quickly along with making informed decisions.

“It is imperative to note that the desired outcomes of the data mining and trending analysis will not be realized without effective deployment of information technology tools that will ensure standardization of protocols and strict adherence to best practices,” Dr Refaat said.

Posted by : Dubai PR Network Editorial Team
Viewed 16610 times
PR Category : Others
Posted on : Thursday, June 20, 2013  7:47:00 PM UAE local time (GMT+4)
Replication or redistribution in whole or in part is expressly prohibited without the prior written consent of
Previous Story : Brazilian autoparts shipments to Arab countries exceed USD 5...
Next Story : AIMCO Accepts “Export Leader Award”
Email this article Print this article

Share this article with your friends and followers
Back to Section Home

Related Stories

Most Viewed Press Release posted in the last 7 days
Korea's Number One Beauty Brand Innisfree All Set to Celebrate the Grand Opening at the Du... [10266-Views]
Sephora: Are You Ready to Join the #SephoraSquad? [9650-Views]
Emirates Post Issues Set of Commemorative Stamps for the New Logo for People of Determinat... [9211-Views]
How to Beat Pigmentation with DERMAdoctor [8839-Views]
Introducing Zeitun Premium Face Care Collection [8717-Views]
Cerruti 1881 - Special Product Launch for Mother's Day [8448-Views]
Rate Hawk is Live with Global Innovations Flagship Product TassPro and Itinerary [8369-Views]
Spoil her this Mother's Day with gifts from Marks & Spencer [8345-Views]
Enjoy a Selection of Anti-Aging Products from Beauty Solutions [7607-Views]
Achieve Gorgeous and Radiant Skin in Only 90 Seconds [7412-Views]
Swatch X 007 – Introducing the New James Bond Collection and Limited Special Edition [6661-Views]
Ferragamo Sapphire Collection [6381-Views]
Tag Heuer Opens Boutique at Mall of the Emirates [6301-Views]
TBO Holidays Hotel XML API Integrated with TassPro and Itinerary HomePR & EventsTBO Holida... [6204-Views]
Dubai Chamber Honours Top-performing Trading Companies [6070-Views]
HRH the Prince of Wales Officially Opens the National Automotive Innovation Centre [5844-Views]
Get Great Hair Naturally With HASK's Latest Haircare Collections This Spring! [5624-Views]
HH Sheikh Mansour bin Mohammed Visits Dubai Sports Council [4929-Views]
Mall of Oman Onboards a Host of Global Lifestyle, Fashion, and F&B Brands Ahead of Its 202... [4679-Views]
Marks & Spencer Unveils its All New Menswear [4557-Views]
Etihad Airways to Operate Special Flights From Al Ain to Jeddah During Ramadan [4355-Views]
Statement Stilettoes from Steve Madden [4197-Views]
Stars Join OMEGA at the Olympia Bob Run in St. Moritz [4191-Views]
Visit of Punjab Minister at Al Maya Stand @ Gulfood 2020 [4136-Views]
Dubai Cares Donates 2,000 Books to Wanna Read? Initiative to Instill the Habit of Reading ... [4130-Views]
RSS Facebook Twitter LinkedDin
Top Sections
Top Stories