Inpatient Payment Policy Collection
Learn about our compilation of existing, enhanced, and net new inpatient claim policies developed and deployed in PPM and Coding Validation.
According to CMS data, improper payment rates are on the rise from pre-pandemic levels in 2019, with payers spending a staggering $31 billion in 2022 on improper payments. This amount includes a large portion from inpatient facility claims, whose complexity often leads payers to bypass inpatient claim editing, resulting in millions of dollars in overpayments that could have been prevented. While postpay audit and recovery programs are a necessary safety net to validate inpatient claim overpayments, prepay editing and review can accurately catch most mistakes before the claim is paid, reducing administrative work and provider abrasion.
Read our policy on a page and learn how Cotiviti's Inpatient Payment Policy Collection delivers incremental savings value by preventing overpayment.