最高の Healthcare Analytics ポッドキャスト (2024)

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Episode 18 - The insider's guide to clinical appropriateness 18:37

5y ago18:37

18:37

When a health plan is deciding whether to pay a claim, there’s no shortage of information to consider and reviews that must be performed, including medical coding and documentation. And perhaps the most challenging question to answer is this: is the information on the claim clinically appropriate? On episode 18 of “From the Trenches” podcast, we sp…

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Episode 17 - How to step up claim overpayment recovery results 11:09

5+ y ago11:09

11:09

Payment accuracy programs are critical to delivering value to health plan members. Some plans excel at recovery management while others struggle—and the difference in financial results is significant. But regardless of size, any health plan can improve its recovery results by pulling a few key levers. Cotiviti's Chris Mastro, vice president of oper…

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Episode 16 - The keys to successful claim overpayment recovery 7:38

5+ y ago7:38

7:38

For health plans, managing payment recovery is very challenging and hard to accomplish without negatively impacting their net promoter scores. And this proves especially difficult when using collection agencies that are not experts in claims payment and the plan’s individual overpayment concepts. On the latest episode of our “From the Trenches” pod…

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Episode 15 - How to sharpen your inpatient auditing program with better chart selection 7:42

5+ y ago7:42

7:42

Although the cost of inpatient hospital stays continues to rise, health plans are finding that their inpatient claim auditing programs are returning less value. They’re also facing challenges such as provider abrasion resulting from requesting too many medical charts to validate those claims, which makes it more difficult to successfully retrieve m…

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Episode 14 - Excellus BlueCross BlueShield's data lake journey 8:13

5+ y ago8:13

8:13

As they look to tame their data and turn it into actionable insights, many payers are significantly ramping up their data analytics strategy by building a data lake, housing both structured and unstructured data. Serving 1.5 million members, Excellus BlueCross BlueShield of New York is making significant progress on its own data lake journey. We sp…

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Episode 13 - A path to success in the changing data management landscape 12:31

6y ago12:31

12:31

The longstanding barriers to data sharing between healthcare organizations have been breaking down over the past decade, removing a major obstacle to partnerships between payers and providers. But major challenges remain, as data management only continues to grow in complexity and healthcare organizations try to make sense of a flood of information…

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Episode 12 - Fighting healthcare fraud and abuse with NHCAA 9:57

6y ago9:57

9:57

Healthcare organizations must constantly improve their technologies and processes to stay one step ahead of healthcare fraud. So, what does the leading national organization focused on the fight against healthcare fraud see on the horizon in this ongoing battle? On the latest episode of our “From the Trenches” podcast, we sit down with Louis Saccoc…

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Episode 11 - How clinical validation is good for payers, providers, and patients 7:40

6y ago7:40

7:40

When a health plan denies a claim, the provider wants to know why it was denied. Sometimes, the answer is that a modifier appears to have been used inappropriately, which Cotiviti detects using a process we call clinical validation. And as it turns out, clinical validation doesn’t just lead to better outcomes for the payer, but also the members and…

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Episode 10 - How risk adjustment coding validation gives health plans more certainty 13:46

6+ y ago13:46

13:46

Compliance is becoming an increasingly difficult challenge for Medicare Advantage plans, especially when it comes to their risk adjustment programs. When CMS selects plans for a risk adjustment data validation (RADV) audit, they need to have a high degree of certainty that their diagnoses submitted for reimbursement are valid. So, what’s the soluti…

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Episode 09 - Navigating to better Star Ratings performance 13:35

6+ y ago13:35

13:35

You’ve submitted your final data to NCQA and CMS, marking the end of the HEDIS® 2018 marathon. Now it’s on to the next challenge: Star Ratings performance. In the latest episode of Cotiviti's “From the Trenches” podcast, we wrap up this year’s HEDIS season, discuss the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, …

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Episode 08 - The final sprint to the HEDIS 2018 finish 7:08

6+ y ago7:08

7:08

The countdown is on for the June 15 deadline to submit your HEDIS 2018® data, and there’s no shortage of details to keep track of to ensure your submission is accurate, locked on time, and approved by your auditor. We hear from Cotiviti product manager Jamison Gillitzer and senior data analyst Charan Govind, who offer important reminders to help he…

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Episode 07 - Validating clinical claims without medical record review 7:30

6+ y ago7:30

7:30

Automated claim editing systems are a crucial component of accurate and efficient claims payment. But there will always be claims that are too complex to be auto-adjudicated and need a human touch. So, what exactly do you need to clinically validate a claim? We talk with Kris Jensen, registered nurse and clinical consultant for Cotiviti's Payment A…

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Episode 06 - Are you ready for medical record review validation? 4:15

6+ y ago4:15

4:15

The HEDIS® 2018 deadline for submitting your medical record review validation (MRRV) data is earlier this year than in years past. Are you prepared? On this episode, our monthly dive into HEDIS season continues as we get tips for MRRV success from Carrie Taylor and Holly Conk, managers of HEDIS abstraction for Cotiviti.…

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Episode 05 - Are you catching all types of duplicate claims? 8:29

6+ y ago8:29

8:29

Is your claim editing system catching all types of duplicate claims, or are many of them passing through and getting paid? And if so, what can you do about it? We talk with John Neumann, registered nurse and clinical consultant for Cotiviti's Payment Accuracy solutions, who breaks down common misconceptions about duplicate claims and describes how …

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Episode 04 - Sifting the 2019 Medicare Advantage final rate notice 12:19

6+ y ago12:19

12:19

The Centers for Medicare & Medicaid Services (CMS) has released its final 2019 Medicare Advantage and Part D Rate Announcement and Call Letter. What are the key takeaways for Medicare Advantage plans and their risk adjustment programs? We dive in with vice president Lesley Brown, who drives the product strategy for Cotiviti's Risk Adjustment soluti…

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Episode 03 - HEDIS measure changes on the horizon 8:00

6+ y ago8:00

8:00

The National Committee for Quality Assurance (NCQA) is proposing several new measures and measure changes for next year’s HEDIS® season. We examine how this would impact health plans with Jenna Fitcher, product director for Cotiviti's Quality and Performance Solutions, as well as product manager Jamison Gillitzer.…

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Episode 02 - The changing quality landscape 10:25

7y ago10:25

10:25

As payers increasingly use quality data to drive performance improvement initiatives across their organizations, Cotiviti conducted a survey in late 2017 to determine how organizational shifts are affecting their strategy and planning. We look over the results with David Bartley, vice president of Quality and Performance.…

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Episode 01 - Prepping Your HEDIS data 6:05

7y ago6:05

6:05

On the premiere episode of our podcast, we look at how health plans should get their data ready for their HEDIS® production run with Jenna Fitcher, product director for Cotiviti's Quality and Performance solutions, and Geetha Bhatraj, director of data program management.Cotiviti による

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From the Trenches: A Healthcare Analytics Podcast

Cotiviti

1
Episode 18 - The insider's guide to clinical appropriateness 18:37

1
Episode 17 - How to step up claim overpayment recovery results 11:09

1
Episode 16 - The keys to successful claim overpayment recovery 7:38

1
Episode 15 - How to sharpen your inpatient auditing program with better chart selection 7:42

1
Episode 14 - Excellus BlueCross BlueShield's data lake journey 8:13

1
Episode 13 - A path to success in the changing data management landscape 12:31

1
Episode 12 - Fighting healthcare fraud and abuse with NHCAA 9:57

1
Episode 11 - How clinical validation is good for payers, providers, and patients 7:40

1
Episode 10 - How risk adjustment coding validation gives health plans more certainty 13:46

1
Episode 09 - Navigating to better Star Ratings performance 13:35

1
Episode 08 - The final sprint to the HEDIS 2018 finish 7:08

1
Episode 07 - Validating clinical claims without medical record review 7:30

1
Episode 06 - Are you ready for medical record review validation? 4:15

1
Episode 05 - Are you catching all types of duplicate claims? 8:29

1
Episode 04 - Sifting the 2019 Medicare Advantage final rate notice 12:19

1
Episode 03 - HEDIS measure changes on the horizon 8:00

1
Episode 02 - The changing quality landscape 10:25

1
Episode 01 - Prepping Your HEDIS data 6:05

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