Resources.cotiviti.com

What's old is new again: 3 healthcare fraud trends to watch

Reviewing claims data in a silo limits true comprehension of a provider’s billing patterns. Investigators should talk to their health plan … See more

Actived: 2 days ago

URL: https://resources.cotiviti.com/fraud-waste-and-abuse/whats-old-is-new-again-3-healthcare-fraud-trends-to-watch-for-in-2022

Healthcare Payer Resources Medicare Advantage, …

WEBLearn new strategies for engaging health plan members with multi-channel communications to limit disenrollment during the Medicaid redetermination process. These resources …

Category: Health Go Health

CMS 2023 Advance Notice: Health equity takes center stage

WEBIn a statement on the 2023 Advance Notice, America’s Health Insurance Plans (AHIP) president and CEO Matt Eyles expressed support: Over 28 million Americans—44% of …

Category: Health Go Health

Preparing for a “Universal Foundation” of quality measures

WEBCMS says the Universal Foundation quality measures are crucial to promoting health equity. The measures selected are meant to address many of the health problems …

Category: Health Go Health

Preparing for 2024 trends in healthcare FWA: CPT code updates …

WEBEvaluation and management (E&M) codes. Another CPT code update in 2024 affects E&M codes, involving the removal of time ranges from certain outpatient codes, such as …

Category: Health Go Health

Closing the Gap: Improving chronic disease screening and care

WEBHealth plan members engaged with Eliza ®, Cotiviti’s multi-channel member engagement solution, saw a 4.3% higher rate of HEDIS colorectal cancer screening gap closure. In a …

Category: Cancer Go Health

3 areas of investment for payers to improve health equity in 2022

WEBThe State of Massachusetts also invested $2.5 million in community partnerships focused on SDoH, specifically targeting food security and economic mobility. Amid this increased …

Category: Food Go Health

Moving to in-year HEDIS: 5 best practices to boost scores

WEBThe annual HEDIS ® data gathering, reporting, and submission process is typically a retrospective activity: health plans retrieve and abstract medical charts to demonstrate …

Category: Medical Go Health

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 …

Category: Health Go Health

NCQA releases proposed HEDIS MY 2025 updates

WEBEach year, the National Committee for Quality Assurance (NCQA) publishes a list of measure updates, additions, and deletions for future HEDIS ® measure years for public …

Category: Health Go Health

Healthcare Analytics Webinars Cotiviti

WEB2023 Star Ratings Reflections. Take a deep dive with Cotiviti into 2023 Star Ratings as we explore how we got here, share observations, and discuss strategies and interventions. …

Category: Health Go Health

Busted: The top healthcare fraud schemes of Q3 2023

WEBFraud, waste, and abuse (FWA) is an area of constant concern for health plans. Whether inappropriate billing is happening purely by accident, due to lack of correct coding …

Category: Health Go Health

NCQA confirms HEDIS updates for Measurement Year (MY) 2024

WEBWith the August publication of the HEDIS Measurement Year 2024 Volume 2: Technical Specifications for Health Plans, the National Committee for Quality Assurance (NCQA) …

Category: Health Go Health

How to sequence FWA investigations for greater impact

WEBSequence investigations efficiently to increase positive behavior change. Reviewing an allegation begins with data analysis to determine if the billing behavior in question …

Category: Health Go Health

The evolution of DxCG, the gold standard in risk adjustment and

WEBThe evolution of DxCG, the gold standard in risk adjustment and predictive modeling. Updated in 2022 for DxCG's 25th anniversary, this is the story of the birth and evolution …

Category: Health Go Health

Rounding up Star Ratings changes in the 2024 Advance Notice

WEBProposed 2026 Star Ratings (CY 2024) changes. In the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program document released in …

Category: Health Go Health

3 takeaways from CCC23 to improve payment integrity

WEBIn payment integrity specifically, health plan leaders discussed topics including how to improve inpatient claim reviews; prevent fraud, waste, and abuse in emerging areas …

Category: Health Go Health

CMS Star Ratings Calendar

WEBTake a look at this newly updated calendar as a reminder of proposed and confirmed upcoming changes to the CMS Star Ratings system for 2024 and beyond. This calendar …

Category: Health Go Health

Busted: The top fraud schemes of Q1 2023

WEBBusted: The top fraud schemes of Q1 2023. The start of 2023 saw an influx of fraud, waste, and abuse (FWA) cases. Bad actors sought to gain from both public and private payers …

Category: Health Go Health

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