The risk of overbilling for therapeutic services remains a pressing concern for health plan special investigative units (SIUs) and compliance teams. Excessive or inappropriate billing not...
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Learn how prospective analytics and expert review uncovered home health billing errors.
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As 2026 gets underway, here are three key shifts for payment integrity and compliance teams to monitor.
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Learn key trends in E/M utilization and medical drug spend as we address how payment integrity policies can play a proactive role in identifying billing errors.
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Learn the most impactful changes proposed in November 2025 to the CMS Star Ratings program and how to pivot for success in 2026.
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Learn key red flags to look for in healthcare fraud schemes involving services not rendered and how Cotiviti helped identify a multimillion-dollar scheme.
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Review key ICD-10-CM updates and adopt best practices to prepare, adjust, and thrive in the new year.
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Senior leaders from Cotiviti and Edifecs offer strategies for building scalable risk adjustment technology initiatives while navigating rising business and regulatory pressures.
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Learn how to maintain or even boost your Star Ratings as hybrid measures are retired and digital quality becomes the norm.
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Learn the latest insights and approaches to preventing E/M over-coding.
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A robust coordination of benefits (COB) program can be one of the most difficult elements for health plans to achieve in creating a stronger payment integrity strategy. As rising...
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Learn how artificial intelligence can be deployed practically to improve payment integrity and value-based payment operations.
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Learn how phantom provider schemes work and how to stop them with prepay fraud, waste, and abuse interventions.
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Combine prospective, concurrent, and retrospective approaches for a comprehensive risk adjustment program.
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Review the 2026 Star Ratings results, examine key measures and cut point impacts, and learn practical recommendations for boosting Star Ratings performance.
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Learn how self-insured employers can safeguard their employees' healthcare premiums with robust payment integrity programs.
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2026 is coming up fast and health plans should be preparing risk adjustment programs accordingly, with coding accuracy as critical as ever for securing appropriate reimbursement and...
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Learn how to spot red flags in billing for intensive outpatient programs (IOPs) with these insights from Cotiviti's FWA team.
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Learn the impact of the latest changes in risk adjustment for 2026 and beyond.
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Read a structured breakdown of confirmed changes to the MY 2026 HEDIS Technical Specifications and strategies to enable health plans to prepare.
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