Cotiviti

Medical record retrieval, coding, and interoperability are at the core of a successful risk adjustment program. In our latest LinkedIn newsletter, Cotiviti's Chad Kinkead explains the fundamentals of a successful partnership between health plans and external partners that can provide these capabilities. 📰

CMS has finalized a rule designed to limit the financial impact of fraudulent billing on accountable care organizations participating in the Medicare Shared Savings Program (MSSP). The rule focuses on suspect billing practices, including significant spikes in claims for urinary catheters. https://bit.ly/4ejETTg Fierce Healthcare Centers for Medicare & Medicaid Services #HealthPlans #payments #FWA

In today’s healthcare landscape, efficient medical record retrieval is essential for maintaining payment integrity. Learn how a regional health plan faced significant challenges in this area but achieved remarkable results by partnering with Cotiviti. Download our case study about leveraging AI-enabled chart selection. https://bit.ly/4e2iQjR #healthcare #payments #HealthPlans

The HEDIS Measurement Year (MY) 2023 season has concluded, and this Cotiviti on-demand webinar reflects on outcomes and strategically prepares for MY 2024. Watch on YouTube and subscribe. https://bit.ly/4g4Byso Samantha Davis Branka Sustic Jamison Gillitzer #HealthPlans #HEDIS #healthcare

After the continuous Medicaid enrollment policy ended in March 2023, states completed the unwinding process, with over 56 million people renewing their coverage. Despite the disenrollment of more than 25 million individuals, Medicaid and CHIP enrollment is still 10 million higher than pre-pandemic levels, according to a new KFF analysis. https://bit.ly/3zNubFu Healthcare Finance News #HealthPlans #healthcare #payments

Data-driven technology such as AI are increasingly essential for payers to uncover the latest fraud, waste, and abuse (FWA) schemes, including Medicaid plans, which are especially vulnerable to inappropriate claims submitted by bad actors. Cotiviti's Matthew Hawley offers a comprehensive perspective on payment integrity, noting that technologies such as AI must be accompanied by clinical expertise to be deployed effectively. Read the four strategies he offers health plans in Health Data Management. https://bit.ly/4efLhuu #payments #HealthPlans #FWA

Remote patient monitoring has seen rapid growth, particularly among Medicare Advantage enrollees, where use expanded 14 times between 2019 and 2022. As total Medicare spending on RPM surged to $311 million, the HHS Office of Inspector General has flagged the potential for misuse and fraud. https://bit.ly/3Y5QgZw HealthLeaders #healthcare #HealthPlans #FWA

Cotiviti is once again proud to sponsor the National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference! Stay tuned as we share what we have in store for you at the Cotiviti booth this year in New Orleans. #FWA

Insurance fraud within physical therapy practices often involves schemes like billing for services not rendered, upcoding, and unbundling. Cotiviti’s special investigations unit (SIU) recently conducted a postpay review of a physical therapy provider, uncovering significant problems. https://bit.ly/4fHYg9D #FWA #healthcare #payments

The increasing demand for GLP-1 drugs like Ozempic and Wegovy is driving up healthcare costs in the U.S. Despite cost-management strategies like prior authorizations, ACA Marketplace plans view these drugs as significant contributors to rising premiums in 2025. https://bit.ly/3TPE4to KFF #payments #HealthPlans