Cotiviti Blog

Cotiviti is empowering a sustainable value-based healthcare delivery and payment system for health plans, employers, and providers.

3 key risk adjustment strategies to drive success in 2024

Cotiviti examines three strategies to improve risk adjustment outcomes for Medicare Advantage plans in 2024 and beyond.

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Webinar: Unlock the “Total Value” of your payment integrity program

An effective payment integrity program goes beyond relying on manual models and targeting low-hanging fruit—yet many payment integrity solutions on the market offer just that. Payment...

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Webinar: Implications of the 2025 CMS Final Rate Announcement for quality programs

In February, the proposed changes announced in the 2025 Medicare Advantage (MA) and Part D Advance Notice released by the Centers for Medicare & Medicaid Services (CMS) allowed plans to...

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4 medical drug payment integrity trends to track in 2024

Learn about spending trends in specialty drugs that impact your payment integrity program.

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Podcast: The "Total Value" approach to payment integrity

Cotiviti's Matthew Hawley, EVP of payment integrity operations, leads a conversation on the dimensions of payment integrity value that go beyond medical cost savings.

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NCQA releases proposed HEDIS MY 2025 updates

Read our detailed breakdown of the HEDIS program changes the National Committee for Quality Assurance (NCQA) has proposed for Measurement Year (MY) 2025.

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Five E/M payment integrity trends to watch

Stay aware of the latest challenges in E/M claims for Cotiviti clients.

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3 interoperability updates for payers in 2024

Cotiviti breaks down three key updates for payers to track as TEFCA comes to life in 2024.

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3 takeaways from the 2025 Advance Notice

Learn how the 2025 CMS Advance Notice will impact Medicare Advantage risk adjustment and Star Ratings.

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Busted: The top fraud schemes of Q4 2023

Some of the top alleged cases of healthcare fraud in Q4 2023 included falsified claims and exploitation of healthcare programs for Native Americans.

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FWA Insights: Examining a suspicious volume of HCPCS codes

Learn how overuse of HCPCS H2014 and HCPCS T1017 led to an FWA investigation by Cotiviti’s SIU.

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Preparing for 2024 trends in healthcare FWA: CPT code updates and beyond

Learn about critical updates to the 2024 CPT code set and other trends impacting healthcare payments.

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Closing the Gap: Improving chronic disease screening and care

Learn how health plans can deliver better care to members with inflammatory bowel disease (IBD), including Crohn's and ulcerative colitis.

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Busted: The top healthcare fraud schemes of Q3 2023

Read about some of the most prominent alleged cases of healthcare fraud, waste, and abuse occurring during the third quarter of 2023.

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FWA Insights: Flagging suspicious activity related to COVID-19 testing

Learn how Cotiviti flagged one provider in 2023 for possible fraud, waste, and abuse (FWA) activity related to COVID-19 drive-through tests.

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Closing the Gap: American Diabetes Month

Learn how to optimize preventative care efforts and improve member engagement for diabetes management.

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Reducing disparities in care during Global Health Equity Week

How can health plans take meaningful steps to reduce disparities in care? HIMSS TV interviews Cotiviti's Leah Dewey for Global Health Equity Week.

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3 takeaways from the 2024 Star Ratings

With Medicare Advantage plans seeing lower scores in the annual Star Ratings for two consecutive years, Cotiviti offers three takeaways for better performance.

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RISE Webinar: Star Ratings Reflections

Each October, the Centers for Medicare & Medicaid Services (CMS) publishes the annual Star Ratings for Medicare Advantage (MA) plans. This release marks a critical moment for MA plans to...

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Podcast: Optimizing inpatient claim review

Learn how health plans can improve payment accuracy for their inpatient claim review programs with AI-driven chart selection and combining prepay and postpay approaches.

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