Blog.cotiviti.com
Case study: Accelerating value-driven care through provider
WebCase study: Accelerating value-driven care through provider specialty tiering. Mac Davis. Leading health plans know that to stay competitive and meet the demands of the members and employer groups they serve, they must proactively increase the value of care they provide while decreasing costs. That’s why one major health plan in North
Actived: 2 days ago
NCQA publishes proposed changes to HEDIS measures for MY …
WebThe National Committee for Quality Assurance (NCQA) has released proposed updates and changes to HEDIS ® measures for Measurement Year 2023 (MY 2023) for public feedback, with the public comment period ending Friday, March 11. Here, we take a look at the new additions, changes, retirements, and discussion points for MY 2023 to help health plans …
3 areas of investment for payers to improve health equity in 2022
WebAs the Centers for Medicare & Medicaid Services (CMS) prioritizes health equity in Star Ratings and the Office of the National Coordinator for Health Information Technology (ONC) advocates for “health equity by design,” health plans are reevaluating how they can simplify the care journey and expand access to care to make meaningful progress toward …
Podcast: improving healthcare tech for a 360° view of
WebPodcast: improving healthcare tech for a 360° view of patient care. What technological advances in data management hold the most promise for improving healthcare delivery in the U.S.? Our Chris Coloian, EVP of Revenue and Growth, recently addressed that topic in a panel discussion at the National Health Policy Conference held last week in
What the numbers mean: ACA risk adjustment transfer payments …
WebA total of 572 issuers participated in the risk adjustment program for the 2018 benefit year, down almost 13 percent from 654 issuers in 2017 and 25 percent from 2016. Blue Plans continue to be the greatest beneficiaries in the individual market, receiving $2.4 billion in total transfer payments in the individual market and $287 million in the
NCQA publishes proposed changes to HEDIS measures for MY …
WebNCQA is proposing to introduce race and ethnicity stratifications to five HEDIS measures for MY 2022 with an expansion to a minimum of 15 measures by MY 2024 to help identify and reduce disparities in care. As the agency states, “this effort builds on NCQA’s existing work dedicated to advancing health equity in data and quality measurement.”.
From the HEDIS® 2019 trenches: preparing for MRRV success
WebIn the latest edition of our blog series, “from the HEDIS ® 2019 trenches,” Jenna Fitcher discusses what Cotiviti did this year to ensure medical record review validation (MRRV) success for our clients, and offers tips for health plans …
5 tips for improving and sustaining member satisfaction
WebWith the HEDIS ® season over and bids having been submitted for calendar year (CY) 2022, Medicare Advantage plans have a breather before summer enrollment education sessions, official Health Outcomes Surveys (HOS), and plan Annual Notice of Changes (ANOCs) are due.. As usual, the “breathing time” is short. In June, J.D. Power released …
Analysis: Behavioral health conditions, risk, and cost
WebAnalysis: Behavioral health conditions, risk, and cost during the COVID-19 pandemic. Leah Dewey. As millions of people found themselves out of work or isolated from loved ones during the COVID-19 pandemic, the added social and economic stress triggered new and exacerbated existing behavioral health conditions.
Full steam ahead: CMS finalizes new condition count model
WebThis alternative model was proposed in the Advance Notice in December 2018 after industry feedback had suggested that the original payment condition count (PCC) model would not improve prediction in the CMS-HCC model for high …
CMS releases ACA risk adjustment transfer payments and HRADV …
WebThe Centers for Medicare & Medicaid Services (CMS) recently released the health plan-specific 2019 benefit year risk adjustment transfer payments. As part of the Affordable Care Act (ACA), these payments move money from health plans that serve healthier populations to those with sicker members. Based on last year’s results, these transfers
Podcast: Welcoming, onboarding, and retaining members in the
WebA new year will soon be upon us, bringing a flurry of health plan activities with it. This includes new member welcome and onboarding, transition of care support, primary care provider (PCP) assignment, and generally making a good first impression to help ensure member satisfaction and retention. In a new podcast, Anne Davis, Cotiviti director
What’s old is new again: 3 healthcare fraud trends to
WebAs the health system bent under the weight of the COVID-19 pandemic, bad actors used this opportunity to devise schemes to extract money from the system through fraud, waste, and abuse (FWA)—and despite the pandemic’s unprecedented nature, their schemes largely utilized the same tactics as previous years.
FWA Insights: Catching schemes related to Ozempic, Wegovy, and …
WebAs new drugs such as Ozempic are continually introduced in the marketplace, health plan SIUs can struggle to keep up. Get help from Cotiviti’s FWA Management and prepay Claim Pattern Review solutions to stay vigilant of emerging schemes in the market and avoid paying for inappropriate claims while protecting your members.
Busted: the top 10 healthcare fraud schemes of Q3 2019
Web1. Nationwide genetic testing scheme: $2.1 billion. Calling it “one of the largest healthcare fraud schemes ever charged,” the Department of Justice has indicted 35 people affiliated with telemedicine companies and cancer genetic testing laboratories.The alleged scheme involved the laboratories paying illegal kickbacks and bribes in exchange for the referral …
Busted: The top healthcare fraud schemes of Q1 2021
WebWhile 2021 has brought renewed optimism over the COVID-19 pandemic, it has also delivered numerous new fraud, waste, and abuse (FWA) cases in healthcare. From billing inaccurate procedures learned via YouTube to defrauding a fund intended to help those with traumatic brain injuries, bad actors continue to find new ways to increase their …
Busted: The top healthcare fraud schemes of Q3 2021
WebIllegal opioid distribution: $5.1 million. A Louisiana doctor was charged with four counts of unlawfully distributing and dispensing controlled substances and one count of conspiracy to commit healthcare fraud. Using his position as owner and operator of a medical clinic, the doctor is accused of illegally distributing more than 1.2 million doses of Schedule II …
Busted: The top fraud schemes of Q1 2022
WebAcupuncture fraud: $1.7 million. A Minnesota acupuncturist is facing charges for Medicare fraud. According to the criminal complaint, she submitted more than $1.6 million in fraudulent service claims and $62,000 in interpreter services. Allegedly, she would bill Medicare for an hour of service when the sessions were generally 30–45 minutes
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