Cotiviti Blog

Health systems should expect increasing pressure to improve risk adjustment accuracy and code capture while reducing administrative burden. Many organizations still rely on manual processes, incomplete or fragment...

To facilitate full and accurate Hierarchical Condition Category (HCC) coding, it is important for providers to take a disciplined approach to documenting medical encounters in patient records. To this end, the

Healthcare administration’s reliance on AI is growing at a rapid rate, making its effect on organizations hard to ignore. For health plans, one of the most pressing shifts is occurring in provider billing, where AI tools...

Improper use of modifier codes in radiology can lead to excessive billing, often misrepresenting radiology services and diminishing trust between providers and health plans. As new requirements and measures emerge...

Risk adjustment is facing intensified regulatory scrutiny with the combined impact of recent updates from CMS, planned RADV audit expansion, and OIG and DOJ enforcement priorities. With greater exposure to potential liabiliti...