Successful value-based care is rooted in collaboration and trust between payers and providers, but adoption of value-based payment models continues to be relatively slow. Amid the...
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Payers and providers are both highly motivated to keep their members and patients healthy, but amid numerous challenges—not the least of which was the major disruption to primary care...
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With the June 15 submission deadline just over a month away, health plan quality departments are in the thick of the HEDIS® Measurement Year (MY) 2020 audits and submissions. But soon,...
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By working in unison, risk adjustment and quality teams can better understand where care gaps exist and the most effective ways to deliver high-value care to disengaged or disenfranchised members.
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While 2021 has brought renewed optimism over the COVID-19 pandemic, it has also delivered numerous new fraud, waste, and abuse (FWA) cases in healthcare.
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To successfully transition from paying for volume to paying for value, Medicare Advantage plans must take a more innovative approach to provider engagement.
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While COVID-19 has shifted many healthcare payers' priorities in the past year, organizations are also looking at where they will make their long-term technology investments once the...
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Health plans complete in-home health assessments (often called health risk assessments) for their members for several reasons: accurately documenting members’ risk burden, supporting...
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Coordination of benefits (COB) requires health plans to navigate significant complexities. The order of benefit determination rules rely on an ever-changing member landscape that is as...
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The National Committee for Quality Assurance (NCQA) is accepting comments through March 11 on proposed changes for HEDIS® Measurement Year 2022 (MY 2022), which will be published in...
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While the COVID-19 pandemic has challenged providers in significant ways, it unfortunately has also created new opportunities for a small handful of bad actors to take advantage of the...
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As many health plans know, achieving a higher Star Rating will soon be more challenging. The Centers for Medicare & Medicaid Services (CMS) is changing the makeup of the rating system,...
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In the summer of 2020, Cotiviti released a new health risk map to help determine which states might see serious, medically attended novel coronavirus (COVID-19) cases. At the time, we...
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To build a successful quality improvement program, health plans not only must stay ahead of annual changes to HEDIS® reporting requirements, but also a continually expanding list of...
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Numerous bad actors in healthcare continued to be at large in 2020, exploiting the COVID-19 health crisis and taking advantage of health plans and their members. In Q4, healthcare fraud...
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Payment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery management while others struggle—and the difference in financial results is significant.
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Managing payment recovery is very hard to accomplish without increasing provider abrasion. And this proves especially difficult when using collection agencies that aren't experts in healthcare claims.
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As numerous regions around the country see surges of COVID-19 outbreak, Cotiviti's Outbreak Tracker continues to accurately predict which counties are at risk within the next seven to...
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The public comment period has just closed for the calendar year (CY) 2022 Medicare Advantage (MA) and Part D Advance Notice recently released by the Centers for Medicare & Medicaid...
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As they look to tame their data and turn it into actionable insights, many payers are significantly ramping up their data analytics strategy by building a data lake.
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