As commercial group medical costs are expected to rise nearly 9% in 2026, health plans are contending with an increasingly high‑stakes challenge: ensuring inpatient claims are paid accurately in an environment where clinical scenarios, coding behaviors, and utilization patterns are rapidly shifting.
Inpatient stays remain one of the most expensive categories of care, and the inherent complexity of clinical documentation, DRG assignment, and medical record review means that errors can easily go undetected. In fact, many plans still bypass inpatient claim editing altogether because of that complexity, leading to millions of dollars in preventable overpayments and significant operational strain downstream.
Traditional postpay approaches are no longer sufficient. When errors surface only after payment, plans typically recoup just 70% of the identified overpaid amount, often requiring over 90 days to recover funds—and adding administrative burden for both payers and providers. Prepay review offers a far more effective model by eliminating the pay‑and‑chase cycle, reducing leakage, and catching inaccuracies before payment. As claim trends across high-stakes admissions like sepsis, skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and more continue to evolve, health plans need more agile, clinically informed inpatient review strategies to reduce inappropriate spend.
Gain these strategies by joining me and my colleague Jena Reilly, senior product director, as we launch Cotiviti’s 2026 Payment Integrity Pulse quarterly webinar series on Thursday, March 26 at 1 pm ET.
In our first live session, we’ll explore:
Key inpatient claim trends driving 2026 cost growth
How review processes must flex across prepay and postpay environments
Admission types demonstrating meaningful shifts, including sepsis
Real case studies revealing significant overpayments and how they were uncovered
Where payers can modernize inpatient review strategies to reduce avoidable spend
Whether you’re focused improving existing payment integrity workflows or evaluating new approaches, this session will offer practical recommendations you can start implementing in 2026.
This webinar kicks off a year-long series of quarterly conversations covering:
Emerging payment integrity challenges
Trends in utilization, coding, and billing
Regulatory and policy shifts
Innovations across the prepay and postpay continuum
You can opt in during registration to receive updates about future sessions as they are announced. Get the insights you need to strengthen payment integrity, protect your members’ benefits, improve provider relationships, and prepare for what’s ahead in 2026.