Cotiviti

As Medicare beneficiaries review their options and potentially switch coverage during the Annual Election Period, Cotiviti's Leah Dewey offers four proactive strategies to enable Medicare Advantage plans to better connect with their members. Read them in our latest LinkedIn newsletter. ??

Cotiviti's experts reflect on the HEDIS Measurement Year (MY) 2023 outcomes and review how to prepare for MY 2024. Learn as we unpack the past year's results and delve into: ?? In-depth analysis of the outcomes of MY 2023 ?? Strategies to effectively prepare for MY 2024 ?? Actionable insights to set the stage for a successful journey into the next HEDIS cycle. Watch and subscribe on YouTube: https://bit.ly/4g4Byso #HealthPlans #HEDIS

The latest KFF survey sheds light on a critical issue. Nearly 40% of large employers need to learn how much of the rebates negotiated by PBMs with drugmakers come back to them as savings. With only 19% reporting they receive most of these rebates, this lack of transparency highlights the need for companies to understand better the role PBMs play in their healthcare spending. https://bit.ly/3Y9sYAH HealthLeaders #healthcare #HealthPlans #payments

As HEDIS evolves for MY 2025, the number of hybrid measures is being significantly reduced as the transition to ECDS reporting continues. Cotiviti's Samantha Davis offers a summary of NCQA's latest technical specifications including measure changes, new measures, and measure retirements—as well as recommendations to prepare. https://bit.ly/3XDSxJU #HEDIS #HealthPlans #healthcare

Among other adjustments, CMS's proposed rule for 2026 would recalibrate the federal risk adjustment program, factoring in new data and introducing changes to the treatment of hepatitis C and PrEP services. While this could improve the accuracy of risk models, advocacy groups have raised concerns that the rule must address key issues, such as copay assistance, potentially exposing patients to high out-of-pocket costs. https://bit.ly/3Y8KsNq Fierce Healthcare Centers for Medicare & Medicaid Services #payments #HealthPlans

For health plans, adopting a holistic, coordinated approach to payment integrity that includes second-pass claims editing, AI-driven DRG validation, and proactive COB management can drive significant value. Cotiviti's Matthew Hawley shares that this approach ensures that plans can optimize resources, reduce inappropriate payments, and more in Healthcare Business Today. https://bit.ly/3yLlBH4 #HealthPayers #payments #healthcare

New CMS data reveals that only 40% of Medicare Advantage plans with prescription drug coverage will earn four or more stars in 2025, a continued decline from previous years. Star Ratings are crucial in helping beneficiaries compare plan quality and directly impact insurers' financial performance, with ratings determining eligibility for bonuses and competitive bidding opportunities. https://bit.ly/4f0dMws Healthcare Dive Centers for Medicare & Medicaid Services #HealthPlans #payments

Payment integrity is more critical than ever for third-party administrators (TPAs) who work with self-insured plan sponsors. Cotiviti's Michael Jablon explains how TPAs can implement prepay solutions to help ensure accurate claims while preventing inappropriate payments. Read the new white paper and dive into best practices in payment integrity for the self-insurance industry. https://bit.ly/3BH5pYp #payments #healthcare

Deloitte’s latest analysis shows that improving health equity could add $2.8 trillion to the U.S. economy by 2040, with corporate profits increasing by $763 billion. Addressing health gaps isn’t just a moral imperative—it’s an economic opportunity. By investing in workforce health and community well-being, businesses can improve productivity and prevent workforce losses due to premature death and disability. https://bit.ly/4dB71QG Fierce Healthcare #HealthPlans #payments

Is your fraud, waste, and abuse program evolving to keep up with new #FWA schemes? Join the evolution with Cotiviti at the 2024 NHCAA Annual Training Conference to discover how we're revolutionizing fraud detection. We've got a lot in store for you at booth 415: ?? Try your hand at our "Expert Eye" game to receive an on-the-go travel kit ?? For each participant that completes the activity, a $25 donation will be made to the Boys & Girls Clubs of America ?? Attendees who view a 10-minute demo of our brand-new postpay FWA Pattern Review solution will take home a pair of Loop Experience 2 earplugs We can't wait to see you there! Learn more: https://hubs.ly/Q02WTcF70 #FWA #fraud #payments