Certified Revenue Cycle Management Specialist (RCMS)
Kingdom of Saudi Arabia
Curriculum and Program Overview
Developed by AAPC
In Collaboration with ANOVA & the Council of Health Insurance (CHI)
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OVERVIEW
The objective of the RCMS program is to provide and deliver an efficient and sustainable training program that will give billers, insurance specialists, and medical coders the specific jobs skills and knowledge necessary to be successful in basic revenue cycle management settings within the Saudi Arabia healthcare market.
The program has been developed specifically around the Saudi Arabia coding and billing standards as specified by each of the key regulatory bodies, including the Ministry of Health (MOH), Saudi Health council (SHC), Saudi Commission for Health Specialties (SCFHS), Saudi Central Board for Accreditation of Healthcare Institution (CBAHI), Council of Health Insurance (CHI), and (Saudi Food and Drug Authority (SFDA).
The RCMS program follows a highly effective and proven vocational skills training approach to prepare students for their respective job roles. The following provides an overview of the curriculum and training methods developed for this program.
PROGRAM DETAILS
The revenue cycle management program includes lectures, reading assignments, practice exercises, module review tests, and a final exam. Students must complete a passing score of 70% or more for all module review tests and an overall score of 70% or higher for the final exam.
Students who successfully complete this course will also be eligible to take AAPC’s credentialing exam to obtain the professional credential of Certified Revenue Cycle Management Specialist (RCMS).
Skill Level
Beginner to advanced.
Program Hours
80 program hours.
(Course hours account for time spent in lecture and do not include time spent outside of class for study and homework.)
Time to Complete
Depending on the training schedule, students typically complete this course within 10-16 weeks.
Target Audience
Medical coders, auditors, billers, physicians, nurses, and mid-level providers.
Summary
In this course, you will learn the journey of a patient visit from front desk till the patient is discharged/checked out from the facility. This includes claims submission using insurance protocols, billing regulations, and medical codes.
Program Outline
The program is comprised of 13 modules:
■ Module 1 – Introduction to Healthcare Revenue Cycle Management
■ Module 2 – Healthcare Business Processes
■ Module 3 – Overview of Saudi Billing System: ICD-10-AM, SBS and AR-DRG
■ Module 4- Patient Registration Process and Data Capture
■ Module 5– Insurance Protocols
■ Module 6 – Medical Billing
■ Module 7A – Billing Regulations-Part A
■ Module 7B – Billing Regulations-Part B
■ Module 8 – Denial Management
■ Module 9 – Reimbursements and Collections
■ Module 10 – Compliance and Patient data security
■ Module 11 – Quality in Health care
■ Module 12 – Case Analysis
■ End of Unit Test (100 questions / 4 hours to complete)
Competencies
Students, upon completion of the program, will be able to demonstrate the following competencies needed to properly prepare for the medical claims processing in the healthcare revenue cycle.
- Accurately apply and justify coding and billing conventions when processing the claims
- Understand key fields in the KSA insurance data for CHI to carry out any investigations and analysis to meet its requirements
- Know the standards for minimum data specifications for claims, enrolled data, codes, admission, and discharge specialty reference codes (CHI)
- Identify the key focus for data points required for investigation and data analysis and Ministry of Health minimum data specifications (MOH-MDS)
- Know specific health records requirements as per CBAHI
- Identify the significance of proper coding, policies and protocols on reimbursements, and patient quality of care
- Have an overview of the KSA billing regulations
- Understand how to apply the insurance protocols
- Summarize the Saudi health insurance system and regulatory requirements
- Understand and apply best practices of reimbursement and collections processes within the RCM
- Interpret the case analysis for denied claims
Understand the compliance issues for submitting a claim as per KSA - Know the significance of the clean claim submissions in the quality improvement
ASSESSMENT & EXAMINATION REQUIREMENTS
Quizzes
- 10 quiz questions per module.
- Student has multiple attempts along with rationales.
- Quiz questions will vary upon each attempt.
- No minimum score is required.
Practical Application Exercises
- 10 practical application exercises per module.
- Student has one attempt.
- Correct answers are provided, along with rationales.
- No minimum score is required.
Module Reviews
- 25 questions with rationales.
- 2 hours to complete the exam.
- Requires passing score of 70%.
- Student has two attempts to successfully pass the chapter reviews.
End of Unit Test
- 100 question /4 hours.
- Requires 70% score to pass.
Certification Exam
Once students have successfully completed the training program, they will have the skills and knowledge necessary to challenge the professional certification exam administered by AAPC. Students who successfully pass this certification exam will be recognized with aCertified Revenue Cycle Management Specialist (RCMS) credential.
Professional certification is an important step as it is used to validate RCMS’s knowledge, skills, and expertise against an established industry standard recognized around the world to ensure professionals meet a baseline level of qualifications.
Certification Exam Requirements:
- 90 multiple choice questions.
- 10 case studies (case analysis mix of various denial types).
- Exam must be completed within four hours.
- Passing score of 70% or higher.
TRAINING OPTIONS
Online Self-Paced Training
The online self-paced course is designed for students who want complete flexibility to follow their own schedule and study independently. AAPC coaches will be available to answer questions via email or chat.
Students have up to 12 months to complete the course.
Virtual Live Training
Students attend regularly scheduled live class sessions online where they participate in lectures and interact with the instructor and classmates virtually.
Course is 16 weeks in duration with 2-hour classes being held approximately 3 times per week.
- Chapter Lectures: Including online learning modules
- Reading Assignments: Using our study guide and
course textbook - Module Quizzes: Online quizzes after each chapter to help assess student comprehension
- Chapter Tests: Tests after each chapter designed to help prepare students for the Final Exam
- Practical Application Work Assignments: Case studies mirroring real life scenarios
- Final Exam: Final course exam to pass the course, also helps prepare students for the Certification Credential Exam
ABOUT US
About AAPC
With over 220,000 members in 43 countries, AAPC is the world’s largest training and credentialing authority for medical coding, billing, and health information management professionals. AAPC is recognized by governments, employers, and association groups as the gold standard in medical coding and health information management. AAPC offers 30+ professional credentials and certifications, and each year conducts over 60,000 certification exams in 3,700 locations around the world. All of this is done with the goal of preparing working professionals with the specialized skills and expertise needed to be successful in today’s complex health care system.
About ANOVA
ANOVA is one of the first Saudi licensed companies to venture into Revenue Cycle Management (RCM) services and Technology. Through careful acquisitions and hand-picked professionals, we have firmly established ourselves as the Quality reference in the industry. As the Kingdom moves forward with vision 2030 to develop all aspects of life; healthcare takes a central role. As an entity with means and knowledge, we felt responsible for supporting this progress. Thus, ANOVA health was founded. Healthcare is going through a transformation, and we aim to be the protagonists of it. ANOVA will be the next leading name in healthcare services, applications, and training. We are committed to leading the change in the healthcare industry in the kingdom, including the new regulation at the healthcare business and it's implementations and training. The components of our operational solutions and technologies have been carefully and strategically selected to complement and support each other as they all operate in one ecosystem. Service is coupled with technology, supported by education, training, consultations, and quality management, and integrated with financial services.
https://anovahealth.sa/academy/courses/rcms/
WhatsApp +9664700074
