KPMG Report: Saudi Healthcare Revenue Management System to Undergo Major Transformation

KPMG’s latest report on Revenue Cycle Management (RCM) in the Saudi healthcare sector marks a further step in the Kingdom’s healthcare transformation. As part of Saudi Vision 2030 and the National Transformation Programme, the Ministry of Health is transforming from being an all-in-one payer, provider and regulator of health services to being predominantly a regulator.

The report highlighted that, with the introduction of new service provider reimbursement reforms underway in the public sector in Saudi Arabia and the plan to standardize across the public and private sectors, Kingdom’s healthcare providers will need to develop new capabilities to enable them to be self-sufficient.

“It is a milestone move in Saudi healthcare system which contributes to Saudi Vision 2030. One of the key implications for healthcare providers of this introduction is the transformation of how healthcare service providers are reimbursed. Providers will in the future primarily be paid on a per-patient basis, rather than via allocated budgets from the government,” said Emmeline Roodenburg, Head of Healthcare, KPMG Saudi Arabia.

Under the new reimbursement mechanism, healthcare providers will need to be able to raise invoices to payers for eligible patients. It will create the need for efficient processes from patient acceptance, to treatment and billing and healthcare providers will need to generate and streamline data to negotiate with payers. The same data will drive cost efficiency and service quality and will create competition with local providers.

KPMG report highlights the significant change in how income has been received by the most providers (healthcare providers)in Saudi Arabia. The change requires providers to undergo a culture shift and develop new capabilities in determining which patients are medically and financially eligible prior to registering patients, repeating the check prior to each appointment or the treatment episode, correctly documenting patients’ records, coding and grouping, raising bills according to the contractual terms.

The new system will significantly benefit the healthcare sector in Saudi Arabia. It will bring more insights into the system itself – by using data which is generated by an RCM function, out-competing other providers for increased number of patients because most payments will be revolved around the patient. The system will enable providers to increase their revenues by attracting more patients.

“The new system of reimbursement will raise many challenges for healthcare providers in Saudi Arabia but will also present opportunities to improve and become more efficient by understanding the true costs of delivering services,” said Mostafa Ali ElShamashergi, Head of Financial Management, KPMG in Saudi Arabia and MESA region.

KPMG Case Study

King Faisal Specialist Hospital & Research Center (KFSH&RC), a leading tertiary healthcare facility in Saudi Arabia, was identified by Saudi Ministry of Health as one of the pilot institutions that will move from being a pure government organization to a not-for-profit independent organization.

In order to operate under the new model, the hospital reached out to KPMG to implement RCM to ensure it can meet current and future payer’s requirements and satisfy patient expectations.

KPMG designed RCM processes across the KFSH&RC based on its world-class capabilities, best practices and applicable local regulations.