In today’s evolving healthcare..
Read MoreAt AchieversMD, we understand the critical role payers play in the healthcare ecosystem. We provide specialized solutions tailored to streamline administrative processes, ensure regulatory compliance, and enhance member satisfaction. Our comprehensive services include advanced claims processing, effective denial management, and data-driven insights to improve operational efficiency.
Providers often stay out of network to avoid low reimbursement rates and restrictive contracts. Insurers may offer payments below acceptable levels or require cumbersome credentialing, especially in areas with few insured patients. Additionally, insurers sometimes limit physician panels, hindering doctors from maintaining diverse practices.
While avoiding these pitfalls is beneficial, out-of-network providers face significant reimbursement challenges. Insurers often delay or reduce payments, complicating the process and limiting patient access. This creates a need for skilled advocacy to navigate the reimbursement landscape effectively.
MBS360 bridges this gap with expert solutions for timely reimbursements. We understand the challenges and provide comprehensive support to secure higher reimbursement rates—often up to 2X more than in-network rates. Partner with us to streamline billing processes, reduce administrative burdens, and focus on quality patient care while we handle out-of-network billing complexities.
At AchieversMD, we pride ourselves on delivering a seamless and efficient DME billing process. Our structured approach ensures accuracy, compliance, and optimal financial performance through each step. Here’s how we achieve excellence:
Data Collection and Verification
Documentation and Coding
Claims Submission
Denial Management
Payment Posting
Reporting and Analysis
We are dedicated to providing top-tier services that meet the specific needs of payers. Our team of experts is equipped with the knowledge and experience to deliver solutions that drive efficiency, compliance, and excellence in all aspects of your operations.
Accurate risk adjustment coding is crucial for ensuring appropriate payment for Medicare Advantage and ACA beneficiaries. Our specialized team conducts thorough Hierarchical Condition Category (HCC) coding reviews to ensure accurate documentation and optimal compensation. Our services include:
We streamline quality reporting to enhance star ratings and provide proactive chronic care outreach for high-risk patients. Our services include:
Efficient communication is key to managing member and provider inquiries effectively. Our comprehensive communication services include:
Optimizing provider data and networks is crucial for maintaining efficiency and accuracy in healthcare administration. Our dedicated services ensure that provider networks are well-managed, compliant, and effectively integrated.
AchieversMD’s Clinical Documentation Improvement (CDI) services focus on enhancing the accuracy of coding and billing processes. Our approach ensures that clinical documentation accurately reflects the care provided, aiding providers in receiving proper reimbursement and helping payers process claims efficiently. This accuracy reduces claim denials and supports financial health.
We also emphasize compliance with healthcare regulations, helping providers avoid legal issues while ensuring that payers can process claims smoothly. Our ongoing training and education for healthcare providers maintain high documentation standards, promoting clear and complete information. This collaborative approach fosters an efficient and transparent healthcare system.
With over 12 years of experience and a deep understanding of the U.S. healthcare system, We are dedicated to providing exceptional support to our payer clients. Our comprehensive services are designed to:
Partnering with us allows you to optimize your operations while focusing on your core business.
Maximize Revenue: Through accurate coding, efficient claims management, and proactive chronic care outreach.
Reduce Operational Costs: By utilizing advanced technologies and streamlined processes.
Enhance Member and Provider Experiences: Through effective communication and support services.
Ensure Compliance: By staying up-to-date with regulatory changes and implementing best practices to meet all industry standards.
Improve Data Security: With robust cybersecurity measures that protect sensitive patient and organizational information.
Choosing us means gaining a trusted partner committed to driving your success and helping you navigate the complexities of the healthcare industry.
Members have access to a 24/7 nurse hotline, behavioral health support, and telehealth services, ensuring they receive timely and appropriate care.
We focus on accurate coding and documentation, root cause analysis of denied claims, and implementing corrective actions to minimize future denials. Our proactive approach includes managing the appeals process and continuous monitoring to enhance overall claims performance, resulting in higher approval rates.
Our services optimize revenue through accurate risk adjustment, payment integrity solutions, and support for value-based payment models. We also help contain costs through efficient claims adjudication and network optimization.
We ensure regulatory compliance, implement comprehensive risk management frameworks, and provide robust audit support, protecting your organization from financial risks.
We stand out due to our extensive experience, comprehensive service offerings, innovative technology solutions, and commitment to quality. We provide personalized support, adhere to strict compliance standards, and continuously optimize our services to deliver the best results for our clients.
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