Cotiviti Blog

Webinar: Confronting payment integrity challenges in 2025

Written by Warren Lesnefsky | Mar 13, 2025 6:40:31 PM

Keeping pace with the constant updates to HCPCS codes, CPT codes, and both local and national coverage determinations is no small feat for any payment integrity team. Adding to this complexity are evolving mandates, significant shifts in utilization trends, and the rapid introduction of new specialty drugs. These factors collectively challenge the payment integrity process, requiring health plans to be extra diligent in preventing or recovering inappropriate payments so they can optimize member care.

New in 2025, Cotiviti’s Payment Integrity Pulse webinar series is tailored for payment integrity leaders and experts, delivering up-to-date insights on payment integrity regulations, trends, and innovations. This quarterly webinar series offers expert advice on navigating the complexities of payment integrity throughout the year.

I invite you to join me and my colleagues Amy Hodges, AVP of Content Operations, Amy Carleton, Senior Director of Clinical Chart Validation, and Matthew Herbein, VP of Data Mining for our first webinar on Wednesday, March 26 at 1 pm ET. During this 45-minute webinar, we’ll break down:

  1. The impacts of CPT code changes in E/M: From new telemedicine codes to shifting time requirements, we’ll break down what these changes mean to your payment integrity efforts.
  2. The shift from inpatient to outpatient utilization: As healthcare utilization continues to migrate to urgent care settings, ambulatory surgical centers, and other options, we’ll examine how this impacts your claim review processes.
  3. Medical drug policy challenges: With specialty drug spending showing no signs of abating, we’ll discuss how payers can avoid high-dollar overpayments by helping to ensure these claims are examined and paid appropriately.

Don’t miss this opportunity to deliver better outcomes for your members by reducing wasteful, abusive, and even fraudulent spending. If you can’t attend the live webinar, be sure to register so we can send you the on-demand recording. We look forward to seeing you there.

Case Study: Large Blue Plan achieves data mining success

No matter how robust your payment integrity program, complex claim policies and coding standards can result in high-dollar overpayments for any health plan. Read our new case study and learn how one large Blue Plan adopted Cotiviti’s Data Mining solution, achieving $64M in total recoveries driven by:

  • Customized claim reviews to investigate unidentified billing compliance issues
  • Positive provider experience through fully validated findings and detailed communication
  • High-quality findings with a 97% sustainability rate