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RISK ADJUSTMENT (PAYER)

Risk adjustment audit readiness instills clinical discipline

Summerpal Kahlon, M.D.

Oct 28, 2026

Latest Content

QUALITY AND STARS

Webinar: Decoding the 2027 Star Ratings

Marge Ciancetta

Oct 26, 2026

REGULATORY AFFAIRS

Payer Policy Pulse: October 2026

Krista Baisch

Oct 23, 2026

PAYMENT ACCURACY

Maternity Care Coding 2027: What is changing

Amy Hodges

Oct 22, 2026

RISK ADJUSTMENT (PAYER)

What CMS’s evolving risk adjustment strategy means for health plans

Katie Sender, MSN, RN, PHN, CRC

Oct 15, 2026

INTEROPERABILITY

Bridging the divide between fax and FHIR

Brett Arnold

Oct 14, 2026

RISK ADJUSTMENT (PAYER)

RISK ADJUSTMENT (PROVIDER)

Next in risk adjustment: Auto-linking charts to encounters

John Wilhelm

Oct 12, 2026

RISK ADJUSTMENT (PAYER)

Preparing for what's next: Risk adjustment strategies for 2027 and beyond

Amanda Liu

Oct 8, 2026

INTEROPERABILITY

CMS 57F: A shift from API implementation to member education

Leah Dewey, MPH

Oct 5, 2026

RISK ADJUSTMENT (PAYER)

Closing the year strong: Medicare Advantage risk adjustment priorities for Q4 2026

Amanda Liu

Oct 1, 2026

FRAUD, WASTE, AND ABUSE

Q&A: How to build a more coordinated program integrity strategy

Warren Lesnefsky

Sep 28, 2026

ARTIFICIAL INTELLIGENCE

AI in healthcare: The readiness challenge

Sean Warren

Sep 24, 2026

QUALITY & ENGAGEMENT

Webinar: A strategic approach to Medicare Advantage enrollment shifts

Leah Dewey, MPH

Sep 16, 2026

FRAUD, WASTE, AND ABUSE

PAYMENT ACCURACY

FWA Insights: Identifying non-emergency transportation billing risks

Andrew Winebrenner

Sep 14, 2026

PAYMENT ACCURACY

Modernizing Medicaid through payment integrity, interoperability, and early intervention

Shane McMillan

Sep 10, 2026

FRAUD, WASTE, AND ABUSE

Webinar: Reducing FWA through partnership

Angela Mitchell

Sep 4, 2026

QUALITY & STARS

Webinar: Decoding the latest HEDIS tech specs

Samantha Davis

Sep 1, 2026

FRAUD, WASTE, AND ABUSE

DENTAL CLAIM ACCURACY

PAYMENT ACCURACY

White Paper: Uncovering dental claim errors through advanced analytics

Steven M. Canfield, D.D.S.

Aug 26, 2026

VALUE-BASED PAYMENTS & INSIGHTS

Webinar series: Real AI solutions for value-based care

Demi Plessas, Ph.D.

Aug 24, 2026

PAYMENT ACCURACY

Why prevention is the new standard in coordination of benefits (COB)

Matthew Herbein

Aug 20, 2026

FRAUD, WASTE, AND ABUSE

PAYMENT ACCURACY

FWA Insights: How SIUs can identify misuse of the unlisted home visit code

Dina Ganibegovic

Aug 17, 2026

QUALITY AND STARS

Star Ratings: Navigating Plan Preview season

Taylor Henry

Aug 13, 2026

QUALITY AND STARS

Key takeaways from HEDIS® MY 2025

Jamison Gillitzer

Aug 12, 2026

PAYMENT ACCURACY

The impact of AI-driven provider billing on health plans

Jeremy Mooney

Aug 3, 2026

FRAUD, WASTE, AND ABUSE

Behavioral health FWA: Top concerns for payers

Erin Rutzler, AHFI, CFE, CHC, CPC

Jul 22, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: Providers billing outside of their specialty

Brittny Eberhart, AHFI

Jul 16, 2026

QUALITY AND STARS

Webinar: Breaking down HEDIS MY 2025

Jamison Gillitzer

Jul 14, 2026

RISK ADJUSTMENT (PAYER)

Risk adjustment with AI: Key do’s and don’ts

Summerpal Kahlon, M.D.

Jul 7, 2026

RISK ADJUSTMENT (PAYER)

A patient-centered approach to risk adjustment

Betty Stump, MHA

Jul 1, 2026

INTEROPERABILITY

Interpreting public prior authorization metrics

Jason Van Der Jagt

Jun 29, 2026

QUALITY & STARS

What the Clover Insurance decision means for 2027 QBP determinations

Marge Ciancetta

Jun 26, 2026

RISK ADJUSTMENT (PROVIDER)

Case Study: Improving risk capture with advanced pre-visit prep

Betty Stump, MHA

Jun 23, 2026

RISK ADJUSTMENT (PROVIDER)

Top 3 operational challenges for providers adopting HCC coding

Amanda Liu

Jun 19, 2026

FRAUD, WASTE, AND ABUSE

PAYMENT ACCURACY

Webinar: The impact of AI-driven billing on health plans

Jeremy Mooney

Jun 17, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: Identifying modifier misuse in radiology services

Aron Litostanski

Jun 11, 2026

RISK ADJUSTMENT (PAYER)

RISK ADJUSTMENT (PROVIDER)

eBook: New risk adjustment standards for compliance

Amanda Liu

Jun 3, 2026

RISK ADJUSTMENT (PAYER)

RISK ADJUSTMENT (PROVIDER)

AI for encounter operations: A new layer of intelligence for healthcare data pipelines

Asfandyar Bashir

May 27, 2026

QUALITY AND STARS

2027 CMS Final Rule: What’s changing in Star Ratings and next steps for success

Marge Ciancetta

May 12, 2026

RISK ADJUSTMENT (PROVIDER)

Reexamining standards for better risk adjustment coding

Betty Stump, MHA

May 7, 2026

FRAUD, WASTE, AND ABUSE

Webinar: Waste and abuse in behavioral health

Erin Rutzler, AHFI, CFE, CHC, CPC

May 5, 2026

PAYMENT ACCURACY

Inpatient claim review in 2026: 5 key trends and recommendations

Amy Carleton, RN, BSN

Apr 22, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: New behavioral health codes for APCM services

Adrianne Glanton, MSN, RN, CPC

Apr 15, 2026

RISK ADJUSTMENT (PAYER)

Webinar: How CMS changes will impact risk adjustment in 2027

Betty Stump, MHA

Apr 13, 2026

QUALITY & STARS

Webinar: Decoding the 2027 CMS Final Rule

Marge Ciancetta

Apr 10, 2026

ENTERPRISE DATA ANALYTICS

Correct coding: Why it’s vital across health plan operations

Brad Terry, M.D., M.B.A., CHCQM, CPC

Apr 8, 2026

RISK ADJUSTMENT (PAYER)

RISK ADJUSTMENT (PROVIDER)

RISE highlights connected data, early intervention

Amanda Liu

Apr 1, 2026

PAYMENT ACCURACY

eBook: Future-proofing payment integrity

Warren Lesnefsky

Mar 25, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: Identifying adult day health billing schemes

David Kaahaaina

Mar 18, 2026

PAYMENT ACCURACY

Webinar: Inpatient claim review trends and challenges

Amy Carleton, RN, BSN

Mar 16, 2026

QUALITY & STARS

HEDIS MY 2027 Public Comment: What to know

Samantha Davis

Mar 10, 2026

QUALITY AND STARS

Webinar: Decoding the HEDIS MY 2027 public comment period

Samantha Davis

Feb 25, 2026

QUALITY AND STARS

RISK ADJUSTMENT

Improving medical record retrieval: 5 best practices

Amanda Liu

Feb 12, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: The top fraud schemes of 2025

Erin Rutzler, AHFI, CFE, CHC, CPC

Feb 10, 2026

QUALITY AND STARS

RISK ADJUSTMENT

2027 CMS Advance Notice: 4 key updates

Betty Stump, MHA

Feb 5, 2026

RISK ADJUSTMENT

Webinar Series: Mastering risk adjustment essentials in 2026

Katie Sender, MSN, RN, PHN, CRC

Feb 3, 2026

FRAUD, WASTE, AND ABUSE

FWA Insights: Preventing overbilling in therapeutic home services

Mary Cate Hay, AHFI, HCAFA

Jan 26, 2026

QUALITY AND STARS

Webinar Series: Decoding quality throughout 2026

Branka Sustic

Jan 21, 2026

FRAUD, WASTE, AND ABUSE

3 key payment integrity trends to watch in 2026

Megan Brennan, CPC, CPCO, CPMA, CFE

Jan 13, 2026

QUALITY AND STARS

Star Ratings reset: How MA plans can prepare

Marge Ciancetta

Dec 16, 2025

RISK ADJUSTMENT

Checklist: Creating a comprehensive risk adjustment program for the new year

Amanda Liu

Dec 10, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Billing for services not rendered

Heather Weible, CPC

Dec 8, 2025

PAYMENT INTEGRITY

Webinar: Upcoming regulations and their potential payment integrity impact

Warren Lesnefsky

Dec 4, 2025

RISK ADJUSTMENT

Navigating the 2026 ICD-10-CM coding updates

Katie Sender, MSN, RN, PHN, CRC

Dec 2, 2025

RISK ADJUSTMENT

Podcast: An innovation roadmap for risk adjustment strategies

Kassi Yozzo

Nov 24, 2025

PAYMENT INTEGRITY

eBook: Setting up for coordination of benefits (COB) success

Evan Okulanis

Nov 12, 2025

PAYMENT INTEGRITY

The practical landscape of AI in payment integrity and VBP

Brett Arnold

Nov 5, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Stopping “phantom providers” with prepay intervention

Erin Rutzler, AHFI, CFE, CHC, CPC

Nov 3, 2025

QUALITY AND STARS

2026 Star Ratings: What they mean and what comes next

Marge Ciancetta

Oct 29, 2025

PAYMENT INTEGRITY

Case Study: Regional Blue Plan performs beyond hype with Data Mining

Kevin Laskey

Oct 23, 2025

RISK ADJUSTMENT

Webinar: Navigating 2026 coding updates for risk adjustment success

Katie Sender, MSN, RN, PHN, CRC

Oct 21, 2025

QUALITY AND STARS

Webinar: Decoding the 2026 Star Ratings

Marge Ciancetta

Oct 17, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Appropriate billing of intensive outpatient programs

Katie Lewis, RN, BS, CPC

Oct 15, 2025

QUALITY AND STARS

Case Study: How one plan transformed its Star Ratings strategy

Dani Sutherland

Oct 13, 2025

RISK ADJUSTMENT

Preparing for 2026: Adapting to new risk adjustment regulations

Katie Sender, MSN, RN, PHN, CRC

Oct 9, 2025

QUALITY AND STARS

MY 2026: Breaking down the latest HEDIS Technical Specifications

Samantha Davis

Oct 7, 2025

PAYMENT INTEGRITY

Case study: Regional plan exceeds expectations with second-pass COB

Evan Okulanis

Oct 2, 2025

QUALITY AND STARS

Star Ratings Plan Preview: 4 key recommendations

Thelma Belli

Sep 29, 2025

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q2 2025

Erin Rutzler, AHFI, CFE, CHC, CPC

Sep 25, 2025

PAYMENT INTEGRITY

Webinar: Deploying AI effectively and responsibly in payment integrity

Brett Arnold

Sep 17, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Q&A with the SIU

Heather Rickards, MS, AHFI, CFE

Sep 15, 2025

PAYMENT INTEGRITY

7 key steps to build a valuable COB program

Evan Okulanis

Sep 11, 2025

FRAUD, WASTE, AND ABUSE

eBook: Addressing dental overbilling to improve payment integrity

Steven M. Canfield, D.D.S.

Sep 9, 2025

RISK ADJUSTMENT

Webinar: Prepare for risk adjustment in 2026

Katie Sender, MSN, RN, PHN, CRC

Sep 4, 2025

COTIVITI LEADERSHIP

Perform Beyond Expectations: Delivering a true solution

Susan Murray

Sep 2, 2025

QUALITY AND STARS

Webinar: Decoding the HEDIS MY 2026 Tech Specs

Samantha Davis

Aug 28, 2025

COTIVITI LEADERSHIP

Perform Beyond Doubt: Turning uncertainty into informed action

Susan Murray

Aug 26, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Identifying a DME dropshipping scheme

Nikki Brody

Aug 21, 2025

COTIVITI LEADERSHIP

Perform Beyond Hype: Going beyond buzzwords in healthcare

Susan Murray

Aug 19, 2025

QUALITY AND STARS

Decoding HEDIS® MY 2024 for success in MY 2025

Jamison Gillitzer

Aug 14, 2025

COTIVITI LEADERSHIP

Perform Beyond Silos: Uniting people, programs, and partners across healthcare

Susan Murray

Aug 12, 2025

CONSUMER ENGAGEMENT

Webinar: Enhancing member engagement and communication

Leah Dewey, MPH

Aug 5, 2025

PAYMENT INTEGRITY

Two key claim trends and their impact on payment integrity

Jonathan Edwards

Jul 30, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Uncovering improper billing in urine drug screens

Heather Rickards, MS, AHFI, CFE

Jul 17, 2025

RISK ADJUSTMENT

Unlocking business value through interoperability: 3 key strategies

Katie Devlin, DHSc, MS, CPHIMS

Jul 15, 2025

PAYMENT INTEGRITY

Case study: Prepay COB boosts payment integrity results for large national payer

Evan Okulanis

Jul 10, 2025

COTIVITI LEADERSHIP

CCC25: 3 key pillars required to perform beyond healthcare challenges

Susan Murray

Jul 8, 2025

QUALITY AND STARS

Webinar: Reflecting on HEDIS MY 2024 and preparing for what’s next

Jamison Gillitzer

Jul 1, 2025

PAYMENT INTEGRITY

Webinar: Billing and policy trends impacting your payment integrity program

Jonathan Edwards

Jun 18, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Excessive dental restorations

Meagan Baxley, MBA, RDH

Jun 16, 2025

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