Cotiviti Blog (2)

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MEDICARE ADVANTAGE CONSUMER ENGAGEMENT

Cultivating a strategic advantage during Medicare enrollment shifts

Leah Dewey, MPH

Oct 20, 2026

Latest Content

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

FRAUD, WASTE, AND ABUSE

FWA Insights: Skin grafts and substitutes

Jamecia Cousar

Apr 9, 2025

PAYMENT INTEGRITY

Case study: The value of cross-payer analytics

Jonathan Edwards

Apr 2, 2025

FRAUD, WASTE, AND ABUSE

Busted: The top healthcare fraud schemes of Q4 2024

Erin Rutzler, AHFI, CFE, CHC, CPC

Mar 19, 2025

PAYMENT INTEGRITY

Webinar: Confronting payment integrity challenges in 2025

Warren Lesnefsky

Mar 13, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Reducing audit abrasion

Heather Weible, CPC

Mar 11, 2025

RISK ADJUSTMENT

White Paper: Preparing for success in Medicare Advantage risk adjustment

Amanda Liu

Mar 5, 2025

QUALITY AND STARS

NCQA releases proposed HEDIS MY 2026 updates

Samantha Davis

Mar 4, 2025

RISK ADJUSTMENT

INTEROPERABILITY

eBook: Driving business value through interoperability

Katie Devlin, DHSc, MS, CPHIMS

Feb 27, 2025

FRAUD, WASTE, AND ABUSE

eBook: How to evolve your FWA program in 2025

Vince Smith, AHFI, CFE

Feb 25, 2025

White Paper: Navigating the transition to digital quality measurement

Jamison Gillitzer

Feb 18, 2025

FRAUD, WASTE, AND ABUSE

FWA Insights: Changes to audio-only telehealth codes sheds light on FWA

Timothy Sak, CPC

Feb 11, 2025

QUALITY AND STARS

Webinar: Breaking down the 2026 CMS Advance Notice

Marge Ciancetta

Feb 5, 2025

FRAUD, WASTE, AND ABUSE

6 key capabilities to advance beyond traditional FWA lead detection

Vince Smith, AHFI, CFE

Jan 27, 2025

QUALITY AND STARS

The 2026 CMS Advance Notice: 3 key takeaways

Branka Sustic

Jan 21, 2025

ENTERPRISE DATA ANALYTICS

Best of 2024: Explore Cotiviti’s top content from last year

Jeff Robinson

Jan 14, 2025

FRAUD, WASTE, AND ABUSE

White Paper: Enhancing dental payment accuracy to combat FWA

Steven M. Canfield, D.D.S.

Dec 18, 2024

FRAUD, WASTE, AND ABUSE

Webinar: Advancing beyond traditional FWA lead detection

Ryan Cleverly, AHFI

Dec 3, 2024

PAYMENT INTEGRITY

Case study: Benefits administrator achieves millions in payment integrity value

Michael Jablon

Nov 25, 2024

RISK ADJUSTMENT

Podcast: Driving lasting impact through interoperability

Kassi Yozzo

Nov 20, 2024

FRAUD, WASTE, AND ABUSE

Realizing the evolution of FWA prevention and management

Warren Lesnefsky

Nov 18, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q3 2024

Erin Rutzler, AHFI, CFE, CHC, CPC

Nov 13, 2024

FRAUD, WASTE, AND ABUSE

Case study: Highmark Wholecare prevents FWA with Claim Pattern Review

Erin Rutzler, AHFI, CFE, CHC, CPC

Nov 6, 2024

CONSUMER ENGAGEMENT

Case study: Engaging members to apply for the Low-Income Subsidy (LIS)

Leah Dewey, MPH

Oct 30, 2024

QUALITY AND STARS

3 takeaways for Medicare Advantage plans from the 2025 Star Ratings

Marge Ciancetta

Oct 28, 2024

PAYMENT INTEGRITY

Webinar: What TPAs need to know about payment integrity

Michael Jablon

Oct 24, 2024

CONSUMER ENGAGEMENT

Proactive member engagement strategies to close gaps in Medicare Advantage

Leah Dewey, MPH

Oct 17, 2024

RISK ADJUSTMENT

Webinar: Key updates to improve coding accuracy in 2025

Katie Sender, MSN, RN, PHN, CRC

Oct 11, 2024

QUALITY AND STARS

Webinar: Decoding the 2025 Star Ratings

Marge Ciancetta

Oct 8, 2024

RISK ADJUSTMENT

Partnering for success in 3 critical areas of risk adjustment

Chad Kinkead

Sep 30, 2024

QUALITY AND STARS

Decoding the HEDIS MY 2025 Technical Specifications

Samantha Davis

Sep 25, 2024

FRAUD, WASTE, AND ABUSE

Webinar: Lessons learned from a successful prepay FWA program

Nikki Brody

Sep 23, 2024

PAYMENT INTEGRITY

Recovering improper costs in SNF and IRF claims

Amy Carleton, RN, BSN

Sep 16, 2024

PAYMENT INTEGRITY

eBook: How AI can drive health plan success

Brett Arnold

Sep 11, 2024

PAYMENT INTEGRITY

4 attributes of a successful specialty drug payment integrity program

Jonathan Starr, PharmD

Sep 3, 2024

CONSUMER ENGAGEMENT

Webinar: Engaging with members at the end of the year

Leah Dewey, MPH

Aug 28, 2024

PAYMENT INTEGRITY

eBook: The three pillars of coordination of benefits (COB) success

Evan Okulanis

Aug 26, 2024

QUALITY AND STARS

Podcast: Star Ratings strategies for smaller MA plans

Marge Ciancetta

Aug 22, 2024

QUALITY AND STARS

Webinar: Decoding the HEDIS MY 2025 Technical Specifications

Samantha Davis

Aug 20, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q2 2024

Erin Rutzler, AHFI, CFE, CHC, CPC

Aug 15, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Catching outlier behaviors in physical therapy claims

Melanie Poole

Aug 8, 2024

RISK ADJUSTMENT

Webinar: Integrating internal and external risk adjustment innovations

Tracey Bradberry

Aug 6, 2024

PAYMENT INTEGRITY

Checklist: How to build a valuable coordination of benefits program

Evan Okulanis

Aug 1, 2024

RISK ADJUSTMENT

Navigating new frontiers in interoperability

Katie Devlin, DHSc, MS, CPHIMS

Jul 30, 2024

PAYMENT INTEGRITY

Podcast: Deploying AI in payment integrity responsibly

Beth Waibel

Jul 29, 2024

RISK ADJUSTMENT

10 tips for a successful commercial risk adjustment program

Katie Sender, MSN, RN, PHN, CRC

Jul 23, 2024

CONSUMER ENGAGEMENT

Navigating new frontiers in member engagement

Leah Dewey, MPH

Jul 23, 2024

PAYMENT INTEGRITY

Podcast: Artificial intelligence in payment integrity

Beth Waibel

Jul 22, 2024

PAYMENT INTEGRITY

FRAUD, WASTE, AND ABUSE

Video: Navigating new frontiers in FWA and payment integrity

Erin Rutzler, AHFI, CFE, CHC, CPC

Jul 16, 2024

RISK ADJUSTMENT

Video: Navigating new frontiers in risk adjustment

Katie Sender, MSN, RN, PHN, CRC

Jul 9, 2024

QUALITY AND STARS

Quality Decoded webinar: Preparing for HEDIS MY 2024

Jamison Gillitzer

Jul 3, 2024

QUALITY AND STARS

Video: Navigating new frontiers in quality improvement

Branka Sustic

Jul 2, 2024

QUALITY AND STARS

What to expect from CMS recalculating Star Ratings

Marge Ciancetta

Jun 24, 2024

PAYMENT INTEGRITY

Webinar: Provider billing accuracy and payment trends

Jonathan Edwards

Jun 19, 2024

PAYMENT INTEGRITY

3 strategies for payers to curb increasing medical loss ratios

Michael Jablon

Jun 17, 2024

PAYMENT INTEGRITY

White paper: Getting self-insured employer groups on board with payment integrity

Matthew Hawley

Jun 13, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Analysis confirms >$1 million in improper claims

Erin Rutzler, AHFI, CFE, CHC, CPC

Jun 10, 2024

PAYMENT INTEGRITY

Case study: Protecting financial integrity with prepay review solutions

Warren Lesnefsky

Jun 5, 2024

PAYMENT INTEGRITY

Podcast: How to build a valuable coordination of benefits program

Beth Waibel

Jun 3, 2024

ENTERPRISE DATA ANALYTICS

Navigating new frontiers in healthcare: 3 takeaways from CCC24

Brett Arnold

May 29, 2024

CONSUMER ENGAGEMENT

5 steps for proactive member engagement following Medicaid redeterminations

Leah Dewey, MPH

May 23, 2024

QUALITY AND STARS

Podcast: New Star Ratings strategies for success in 2025 and beyond

Marge Ciancetta

May 20, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q1 2024

Erin Rutzler, AHFI, CFE, CHC, CPC

May 14, 2024

PAYMENT INTEGRITY

eBook: How to achieve “total value” in payment integrity

Matthew Hawley

May 8, 2024

QUALITY AND STARS

RISK ADJUSTMENT

White Paper: Executing high-performing interoperability programs to enable clinical data

Katie Devlin, DHSc, MS, CPHIMS

May 2, 2024

RISK ADJUSTMENT

3 key risk adjustment strategies to drive success in 2024

Katie Sender, MSN, RN, PHN, CRC

Apr 18, 2024

PAYMENT INTEGRITY

Webinar: Unlock the “Total Value” of your payment integrity program

Michael Jablon

Apr 16, 2024

QUALITY AND STARS

Webinar: Implications of the 2025 CMS Final Rate Announcement for quality programs

Marge Ciancetta

Apr 11, 2024

PAYMENT INTEGRITY

Case study: Coordination of benefits (COB) results soar for large national plan

Evan Okulanis

Apr 9, 2024

PAYMENT INTEGRITY

Podcast: The "Total Value" approach to payment integrity

Jeff Robinson

Mar 26, 2024

RISK ADJUSTMENT

New approaches to enhance risk adjustment at RISE National 2024

Katie Sender, MSN, RN, PHN, CRC

Mar 5, 2024

QUALITY AND STARS

NCQA releases proposed HEDIS MY 2025 updates

Samantha Davis

Feb 28, 2024

RISK ADJUSTMENT

RISE Webinar: Key risk adjustment trends to watch in 2024

Branka Sustic

Feb 26, 2024

QUALITY AND STARS

Quality Decoded webinar series: 2025 CMS Advance Notice

Marge Ciancetta

Feb 20, 2024

QUALITY AND STARS

RISK ADJUSTMENT

3 interoperability updates for payers in 2024

Katie Devlin, DHSc, MS, CPHIMS

Feb 14, 2024

QUALITY AND STARS

RISK ADJUSTMENT

3 takeaways from the 2025 Advance Notice

Branka Sustic

Feb 8, 2024

FRAUD, WASTE, AND ABUSE

Busted: The top fraud schemes of Q4 2023

Erin Rutzler, AHFI, CFE, CHC, CPC

Feb 6, 2024

FRAUD, WASTE, AND ABUSE

FWA Insights: Examining a suspicious volume of HCPCS codes

Melanie Poole

Jan 31, 2024

PAYMENT INTEGRITY

White Paper: Improving payment integrity with inpatient claim review

Cheri Moehring

Jan 29, 2024

FRAUD, WASTE, AND ABUSE

Case study: Integrated prepay and FWA solutions deliver improved claim accuracy

Vince Smith, AHFI, CFE

Jan 24, 2024

FRAUD, WASTE, AND ABUSE

Preparing for 2024 trends in healthcare FWA: CPT code updates and beyond

Mary Cate Hay, AHFI, HCAFA

Jan 17, 2024

QUALITY AND STARS

eBook: Closing care gaps in 12 critical areas in 2024

Chad Kinkead

Jan 11, 2024

PAYMENT INTEGRITY

Case study: The impact of prospective DRG validation

Cheri Moehring

Dec 12, 2023

FRAUD, WASTE, AND ABUSE

Webinar: Preparing for investigative strategies in 2024

Mary Cate Hay, AHFI, HCAFA

Dec 5, 2023

CONSUMER ENGAGEMENT

Case study: Reaching Medicaid members amid redetermination

Leah Dewey, MPH

Nov 30, 2023

QUALITY AND STARS

Closing the Gap: Improving chronic disease screening and care

Jamison Gillitzer

Nov 28, 2023

PAYMENT INTEGRITY

Case study: Data mining for errors yields more accurate pharmacy payments

Matthew Herbein

Nov 16, 2023

FRAUD, WASTE, AND ABUSE

Busted: The top healthcare fraud schemes of Q3 2023

Erin Rutzler, AHFI, CFE, CHC, CPC

Nov 14, 2023

FRAUD, WASTE, AND ABUSE

FWA Insights: Flagging suspicious activity related to COVID-19 testing

Erin Rutzler, AHFI, CFE, CHC, CPC

Nov 8, 2023

CONSUMER ENGAGEMENT

Webinar: A progress report on Medicaid redetermination

Leah Dewey, MPH

Nov 6, 2023

QUALITY AND STARS

Closing the Gap: American Diabetes Month

Marge Ciancetta

Nov 2, 2023

CONSUMER ENGAGEMENT

Video: Reducing disparities in care during Global Health Equity Week

Kassi Yozzo

Oct 26, 2023

QUALITY AND STARS

3 takeaways from the 2024 Star Ratings

Marge Ciancetta

Oct 23, 2023

QUALITY AND STARS

RISE Webinar: Star Ratings Reflections

Ashley McNairy

Oct 12, 2023

PAYMENT INTEGRITY

Podcast: Optimizing inpatient claim review

Jeff Robinson

Oct 10, 2023

QUALITY AND STARS

Closing the Gap: Better preventative measures for breast cancer

Ashley McNairy

Sep 28, 2023

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