المملكة: Urgent: Prohibiting the requirement of prior approval to treat emergency cases in hospitals

Governance of medical interventions

These procedures aim to govern medical interventions and ensure the application of approved practice guidelines, which directly contributes to preventing unnecessary duplication of services, and reducing any practices that may fall under the heading of misuse of medical insurance.

Data requirements vary depending on the type of request submitted, as the information necessary for approving medications differs from requests for medical devices, physical therapy sessions, or dental services, all the way to hypnosis and medical admission procedures.

The Council approved an explicit exemption for emergency cases that threaten the patient’s life or the safety of his organs from the “prior approval” requirement, affirming the right of emergency departments to provide service immediately for cases classified as levels one, two and three after determining the degree of urgency.

The Council obligated service providers to attach supporting medical documents as an integral part of the request, which include vital signs, details of the disease complaint, clinical examination, treatment history, and results of examinations and x-rays to ensure Accuracy of diagnosis.

Medical errors

Doctors must include accurate diagnosis codes according to the international classification “ICD-10-AM” in the claim file, in addition to a clear treatment plan and codes for medical devices and services, to avoid rejection of requests or delay in deciding on them.

He stressed that completing the data correctly radically reduces the rate of medical errors and increases the efficiency of the documentary cycle of treatment, which reflects positively on the patient’s experience and ensures that he obtains his right to treatment as quickly as possible. Possible.

He stated that the accuracy of the data entered by caregivers is the basic foundation for facilitating the flow of approvals, calling on medical facilities to play their essential role in improving the beneficiary’s treatment journey.