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FRAUD, WASTE, AND ABUSE PREVENTION

Dr. Emad Rizk: 3 tips for moving from retrospective to prospective payment integrity

While many health plans have pre-pay automated claim editing in place, other aspects of their payment integrity programs still take a "pay now, review later" approach. This can lead to significant abrasion when the plan identifies an overpayment and goes to collect it from the provider—and any savings are often significantly reduced. That's why Cotiviti CEO Emad Rizk, M.D., offers three strategies in MedCity News to help payers move from inappropriate payment recovery to prevention.

Read his article to learn:

  • How health plans benefit from strengthening their payment policies and improving transparency
  • Why electronic eligibility data is critical
  • What clinical claim coding validation can do to address complex claims that can't be auto-adjudicated

Read the article

 

WRITTEN BY

Jeff Robinson
As senior manager of corporate communications, Jeff oversees several communication initiatives for Cotiviti, including its blog, podcast, and social media presence. Before joining the organization in 2016, he worked in journalism as the morning host and news director for KCPW, a public radio station in Salt Lake City, Utah, and was a proposal writer for ARUP Laboratories. Jeff holds a bachelor’s degree in broadcast journalism from the University of Southern California and an MBA from the University of Utah.

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