Cotiviti

Our team is ready for you here at RISE National 2025 in San Antonio! Stop by the Cotiviti booth to: ➡️ Meet our risk adjustment and member engagement experts ➡️ Play our "Expert Eye" game (Cotiviti will donate $25 to support the Boys & Girls Clubs of America!) ➡️ Pick up an on-the-go travel kit and enter our raffle to win a pair of Beats® Studio Pro Bluetooth wireless headphones See you soon!

Cotiviti's VP of Risk and Quality Solutions, Branka Sustic, shares insights on the 2026 CMS Medicare Advantage and Part D Advance Notice, which introduces a 4.3% average revenue increase for MA plans, driven by several factors. These include risk adjustment model updates and Medicare fee-for-service cost growth. The phase-in of the CMS-HCC risk adjustment model, which began in 2024, will be completed in 2026. However, due to adjustments in the Star Ratings program, a 0.69% decline in quality bonus payments is expected. Learn more in our blog: https://bit.ly/3DatZ4Q

As the Medicare Advantage population grows, accurate risk adjustment becomes more essential. Cotiviti's Amanda Liu explains what you'll learn in our new white paper—and what we have in store for you today and tomorrow at RISE National 2025. 📰⬇️

The introduction of the Health Equity Index (HEI) to Star Ratings methodology highlights the growing importance of addressing health disparities for Medicare Advantage plans. Cotiviti's Marge Ciancetta and Leah Dewey explain why the HEI rewards health plans for achieving high scores in measures that impact vulnerable populations, including dual-eligible members. By focusing on long-term strategies like targeting social determinants of health and improving preventive care, health plans can improve Star Ratings while delivering more equitable care to those who need it most. https://bit.ly/432pns3 Managed Healthcare Executive

AI is reshaping fraud detection in healthcare, but it must complement, not replace human expertise. Fraud, waste, and abuse (FWA) schemes are developing rapidly, and AI tools like machine learning can help health plans identify emerging threats faster than traditional methods. By integrating supervised and unsupervised learning models, plans can detect suspicious activities early and optimize investigative efforts. Read more from Erin Rutzler, Cotiviti's vice president of fraud, waste, and abuse. https://bit.ly/4guuRPu MedCity News

During Women’s History Month, we celebrate trailblazers who have shaped the world in ways that often go unrecognized. One such pioneer is Dr. E. Kitch Childs, a Black feminist, psychologist, and LGBTQ+ activist who dedicated her life to uplifting marginalized communities. She earned her PhD in human development from the University of Chicago in the 1970s, becoming one of the few Black women in the field at the time. She helped found the Association for Women in Psychology and used her expertise to provide therapy for women, LGBTQ+ individuals, and people living with HIV/AIDS—offering care and understanding in a world that often denied them both. Dr. Childs' legacy is one of inclusion and persistence. This Women’s History Month, in partnership with Cotiviti’s Women’s Inclusiviti Network (WIN), we honor her and continue working for a more just world. #WomensHistoryMonth

It’s easy for critical programs like risk adjustment, payment integrity, and quality improvement to operate in healthcare silos, hindering overall organizational goals. Cotiviti works across departments to deliver integrated solutions that improve both clinical and financial outcomes. By focusing on the intersections of these programs, Cotiviti helps health plans deliver better care at lower costs, driving sustainability across the healthcare system. https://hubs.ly/Q035f9qt0

Cotiviti is redefining what it means to be a true partner for health plans. With a combination of cutting-edge machine learning and clinical expertise, we provide results that perform beyond expectations. Our solutions, which span payment integrity, risk adjustment, and member engagement, generate real value—$8B in payment errors corrected annually, $2B in incremental risk adjustment revenue, and a 3–13% improvement in clinical gap closure. Learn how health plans seeking meaningful improvement can rely on Cotiviti for innovative, results-driven support. https://bit.ly/3WP5SQ1

NCQA released proposed HEDIS updates for Measurement Year 2026, continuing the transition to digital-only reporting by 2030. Key changes include new measures for asthma follow-up, tobacco use screening, and disability data collection. There are also revisions to existing measures for immunizations, substance use disorder care, and social needs screening. Read our summary by Cotiviti's Samantha Davis. https://bit.ly/3Dkoi4F

Telehealth provides valuable access to care but also introduces new risks for fraud, waste, and abuse (FWA). Recent CMS updates to telemedicine guidelines, especially concerning audio-only telehealth, have significant implications for coding compliance. In our latest FWA Insights blog, learn how these changes could lead to FWA and discover strategies to mitigate the risks. https://bit.ly/40X1qjt