New dynamics in risk adjustment are prompting health plans to rethink their strategies for 2026 and beyond. With regulatory changes and evolving audit methodologies on the horizon, health...
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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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Coordination of benefits (COB) is an intricate, time-consuming process for all health plans—sifting through data assets, checking validity, establishing primacy, and more. But having a...
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As we await publication of the final 2026 Star Ratings, learn why scores are dropping and strategies for MA plans to close out the calendar year with stronger performance.
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Read our breakdown of 10 major healthcare FWA schemes from April through June 2025—and what they reveal about the evolving tactics of bad actors.
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Learn three key trends across physical therapy in outpatient and professional settings—and the implications for health plans.
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Artificial intelligence (AI) is unlocking numerous possibilities for payers to make costs more sustainable without a negative impact on care quality. According to McKinsey estimates,...
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Cotiviti's FWA investigators break down complex questions related to skin grafts and substitutes, a growing area of concern in healthcare.
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