The development of the Saudi Billing System supporting national health transformation: methods and justification
Abstract
BACKGROUND: The Saudi health transformation program entails a comprehensive reform of all health system functions. One of the pillars of this reform is the health care financing transformation. The Council of Health Insurance (CHI) aims to bring more transparency and understanding of case-mix through the introduction of patient classification and data standardization. Until recently, the private health insurance sector was using a variety of in-house non-standardized billing codes that impeded transparency and a value-based health care (VBHC) financing model. This study enabled the introduction of standardized billing codes known as the Saudi Billing System (SBS).
METHODS: We reviewed and assessed several patient classification and billing systems as part of the assessment phase, followed by data collection from the three largest health insurance companies relating to eighty health care providers. A representative sample of 36,299 patient records were re-coded. Coding was undertaken using the Australian Classification of Health Interventions (ACHI) 10th Edition. Codes were assigned based on assessment by clinical coders using an established methodology and followed by an audit to confirm the assigned code or assign an alternative code where the coding could not be adequately completed by the initial coder.
RESULTS: Seventy-five percent of records were mapped to an existing ACHI code, leaving 25% being a partial match, an approximate match or other (1%, 22% and 2%…
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