Amid the kickoff of HEDIS® season, pending announcements by the Centers for Medicare & Medicaid Services (CMS), open enrollment, and much more, health plans have many priorities to stay on top of as the new year gets underway.
Kick off 2024 with best practices from Cotiviti’s top trending articles, case studies, and white papers of 2023. Set your plan up for success by discovering how to get ahead of upcoming HEDIS and Star Ratings changes, new possibilities for prepayment integrity, ways to improve member engagement, and more. Take a look at the top resources from last year.
Quality measurement and improvement
Prepare for HEDIS and Star Ratings changes in the new year with our most popular quality resources.
- Curious about proposed HEDIS changes in the near future? Read up on the planned changes from the National Committee for Quality Assurance (NCQA) in our blog, Summary: NCQA releases proposed HEDIS changes for MY 2024 and MY 2025.
- In Star Ratings, gain a head start preparing for the latest changes from our blog, Rounding up Star Ratings changes in the 2024 Advance Notice. Discover what to prepare for in 2024 and beyond.
- Stay on track of Star Ratings changes with the CMS Star Ratings calendar. Use it as a reminder of proposed and confirmed upcoming changes to the CMS Star Ratings system.
Member engagement
Amid Medicaid redetermination and other ongoing challenges, learn how reach out to your members with more impactful, targeted communications throughout the year.
- Close quality gaps throughout the whole year across 12 different areas of care. Read our comprehensive Closing the Gap eBook for ideas on how your plan can make sure members’ care needs are met while also improving quality scores.
Payment integrity
Discover how your plan can improve payment integrity efforts with a prepay approach; better flag fraud, waste, and abuse (FWA); and deal with medical cost increases.
- See what a smart prepay integrity system looks like in our white paper, The "smart prepay" approach to payment integrity. Learn the value of beginning with multifaceted prepay review and ending with a vital postpay safety net and prepay feedback loop.
- Learn how our Cotiviti team caught a suspicious code within a behavioral health claim, which led to projected annual savings of approximately $115,000 from a single provider in the case study, FWA Insights: Prepay review leads to >$100K in projected annual savings.
- As health plans realize the impacts of pent-up demand that accumulated during the height of the pandemic and beyond, the largest national payers prepared themselves for a jump in medical costs due to higher-than anticipated utilization in surgeries and other procedures. Learn 4 strategies to curb medical cost increases as healthcare utilization rebounds.
Risk adjustment
Improve interoperability in the new year by optimizing electronic clinical data exchange.
- While TEFCA and the 21st Century Cures Act have spurred progress in interoperability, health plans continue to face challenges to exchange data with providers and partners. What are concrete steps that plans can take to achieve success? Listen to the podcast, Enhancing interoperability for better risk and quality outcomes, to learn more.
There’s much more to come in 2024 as we break down upcoming notices from CMS, annual HEDIS changes from NCQA, the latest trends in payment integrity and FWA, and much more. Keep up with the latest healthcare industry news and strategies from Cotiviti by subscribing to our blog.
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