From the Trenches is a healthcare analytics podcast from Cotiviti (formerly Verscend Technologies), a leading solutions and analytics company that is reshaping the economics of healthcare. On the show, we explore the latest trends in healthcare quality and performance analytics, risk adjustment, payment integrity, and data management. Tweet your suggestions and comments for the podcast to @cotiviti or email email@example.com.
Episode 18 - The insider's guide to clinical appropriateness
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 speak with Marla Wilson, Cotiviti vice president of clinical and coding operations, and Ken Sabulsky, vice president of audit operations. Listen as they dive into how Cotiviti reviews member claim history and medical charts to ensure clinical appropriateness.
Episode 17 - How to step up claim overpayment recovery results
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 operations, once again joins Jeremy Bamford, senior product director for payment accuracy, to look at what drives success in recovering claim overpayments.
Episode 16 - The keys to successful claim overpayment recovery
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” podcast, Cotiviti’s Chris Mastro, vice president of operations, joins Jeremy Bamford, senior product director for payment accuracy, to examine the keys to successful claim overpayment recovery.
Episode 15 - How to sharpen your inpatient auditing program with better chart selection
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 medical records. We talk with Cotiviti product director Jena Reilly about how health plans be more selective and focus on pursuing medical records that will actually return value back to the plan.
Episode 14 - Excellus BlueCross BlueShield's data lake journey
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 speak with Tom Morley, manager of analytics and data strategy for Excellus.
Episode 13 - A path to success in the changing data management landscape
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. Cotiviti chief analytics officer David Costello joins the podcast to discuss the best framework for better data management in healthcare.