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 counterparts both upstream in the prospective … 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

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

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

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 associated …

Category: Health Go Health

Healthcare Payer Resources Medicare Advantage, Medicaid, and

WebOur latest healthcare payer resources. Improve your payment, risk, quality, and member engagement outcomes with the latest healthcare insights from Cotiviti's leading experts …

Category: Health Go Health

3 interoperability updates for payers in 2024

WebThe signing of the 21 st Century Cures Act in 2016 was a long-awaited milestone for interoperability in healthcare—yet with so many regulations and other key details left to …

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

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 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 …

Category: Health Go Health

Healthcare Analytics Webinars Cotiviti

WebPreparing for the unwinding of the Public Health Emergency (PHE) Learn how to prevent disenrollment when the COVID-19 public health emergency (PHE) expires. Cotiviti's …

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

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

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

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 should …

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

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

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 …

Category: Health Go Health

Busted: The top fraud schemes of Q2 2023

WebThe second quarter of 2023 saw a new batch of fraud, waste, and abuse cases targeting both public and private payers. Many of these schemes employed tactics such as …

Category: Health Go Health

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