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เนื้อหาจัดทำโดย Cotiviti เนื้อหาพอดแคสต์ทั้งหมด รวมถึงตอน กราฟิก และคำอธิบายพอดแคสต์ได้รับการอัปโหลดและจัดหาให้โดยตรงจาก Cotiviti หรือพันธมิตรแพลตฟอร์มพอดแคสต์ของพวกเขา หากคุณเชื่อว่ามีบุคคลอื่นใช้งานที่มีลิขสิทธิ์ของคุณโดยไม่ได้รับอนุญาต คุณสามารถปฏิบัติตามขั้นตอนที่แสดงไว้ที่นี่ https://th.player.fm/legal
ที่คล้ายกับ From the Trenches: A Healthcare Analytics Podcast
Africa-focused technology, digital and innovation ecosystem insight and commentary.
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The power of Data is undeniable. And unharnessed - it’s nothing but chaos. Making data your ally. Using it to lead with confidence and clarity. Host Jess Carter is solving problems in real-time to reveal what’s possible. Helping communities and people thrive. This is Data Driven Leadership, a show brought to you by Resultant.
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This is the audio podcast version of Troy Hunt's weekly update video published here: https://www.troyhunt.com/tag/weekly-update/
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We help founders make something people want.
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Redefining AI is the 2024 New York Digital Award winning tech podcast! Discover a whole new take on Artificial Intelligence in joining host Lauren Hawker Zafer, a top voice in Artificial Intelligence on LinkedIn, for insightful chats that unravel the fascinating world of tech innovation, use case exploration and AI knowledge. Dive into candid discussions with accomplished industry experts and established academics. With each episode, you'll expand your grasp of cutting-edge technologies and ...
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The director’s commentary track for Daring Fireball. Long digressions on Apple, technology, design, movies, and more.
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On The Bike Shed, hosts Joël Quenneville and Stephanie Minn discuss development experiences and challenges at thoughtbot with Ruby, Rails, JavaScript, and whatever else is drawing their attention, admiration, or ire this week.
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Mind The Business: Small Business Success Stories
Hitting plateaus is a common milestone in business, but there’s a difference between stability and a rut. In the last installment of this season, we’ll dive into the ways small business owners push beyond plateaus and find new ways to achieve revenue growth. Jannese and Austin wrap up their time in Nashville, Tennessee with a wonderful visit to N.B. Goods to speak with owner Camille Alston . Camille details the times where she hit a wall with profits, the strategies she implemented to increase revenue, what worked, what didn’t, and the important lessons she learned in the process. You won’t want to miss this informative final chapter! Learn more about how QuickBooks can help you grow your business: QuickBooks.com See omnystudio.com/listener for privacy information.…
Episode 15 - How to sharpen your inpatient auditing program with better chart selection
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Manage episode 234087365 series 2136537
เนื้อหาจัดทำโดย Cotiviti เนื้อหาพอดแคสต์ทั้งหมด รวมถึงตอน กราฟิก และคำอธิบายพอดแคสต์ได้รับการอัปโหลดและจัดหาให้โดยตรงจาก Cotiviti หรือพันธมิตรแพลตฟอร์มพอดแคสต์ของพวกเขา หากคุณเชื่อว่ามีบุคคลอื่นใช้งานที่มีลิขสิทธิ์ของคุณโดยไม่ได้รับอนุญาต คุณสามารถปฏิบัติตามขั้นตอนที่แสดงไว้ที่นี่ https://th.player.fm/legal
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.
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18 ตอน
แบ่งปันซีรีส์ที่ถูกเก็บถาวร ("ฟีดที่ไม่ได้ใช้งาน" status)
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This feed was archived on April 07, 2025 14:10 (
Why? ฟีดที่ไม่ได้ใช้งาน status. เซิร์ฟเวอร์ของเราไม่สามารถดึงฟีดพอดคาสท์ที่ใช้งานได้สักระยะหนึ่ง
What now? You might be able to find a more up-to-date version using the search function. This series will no longer be checked for updates. If you believe this to be in error, please check if the publisher's feed link below is valid and contact support to request the feed be restored or if you have any other concerns about this.
Manage episode 234087365 series 2136537
เนื้อหาจัดทำโดย Cotiviti เนื้อหาพอดแคสต์ทั้งหมด รวมถึงตอน กราฟิก และคำอธิบายพอดแคสต์ได้รับการอัปโหลดและจัดหาให้โดยตรงจาก Cotiviti หรือพันธมิตรแพลตฟอร์มพอดแคสต์ของพวกเขา หากคุณเชื่อว่ามีบุคคลอื่นใช้งานที่มีลิขสิทธิ์ของคุณโดยไม่ได้รับอนุญาต คุณสามารถปฏิบัติตามขั้นตอนที่แสดงไว้ที่นี่ https://th.player.fm/legal
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.
…
continue reading
18 ตอน
ทุกตอน
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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.…
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.…
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.…
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.…
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.…
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.…
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 Saccoccio, CEO of the National Healthcare Anti-Fraud Association (NHCAA) at the organization’s 2018 Annual Training Conference.…
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 providers that it serves. On the latest episode of Cotiviti's “From the Trenches” podcast, we talk with John Neumann, registered nurse and clinical consultant for Cotiviti’s Payment Accuracy solutions.…
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 solution? We look at the benefits of coding claim validation with Lesley Brown, Cotiviti vice president of Risk Adjustment.…
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, and introduce Star Navigator, a new solution to enable Medicare Advantage plans to optimize their Star Ratings.…
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 health plans dot their i’s and cross their t’s in these final weeks of the HEDIS 2018 season.…
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 Accuracy solutions.…
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.…
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 health plans can combat them.…
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 solutions.…
F
From the Trenches: A Healthcare Analytics Podcast
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.…
F
From the Trenches: A Healthcare Analytics Podcast
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.…
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.
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ที่คล้ายกับ From the Trenches: A Healthcare Analytics Podcast
BBC Radio 5 live’s award winning gaming podcast, discussing the world of video games and games culture.
…
continue reading
Africa-focused technology, digital and innovation ecosystem insight and commentary.
…
continue reading
Show notes are at https://stevelitchfield.com/sshow/chat.html
…
continue reading
The power of Data is undeniable. And unharnessed - it’s nothing but chaos. Making data your ally. Using it to lead with confidence and clarity. Host Jess Carter is solving problems in real-time to reveal what’s possible. Helping communities and people thrive. This is Data Driven Leadership, a show brought to you by Resultant.
…
continue reading
This is the audio podcast version of Troy Hunt's weekly update video published here: https://www.troyhunt.com/tag/weekly-update/
…
continue reading
We help founders make something people want.
…
continue reading
Redefining AI is the 2024 New York Digital Award winning tech podcast! Discover a whole new take on Artificial Intelligence in joining host Lauren Hawker Zafer, a top voice in Artificial Intelligence on LinkedIn, for insightful chats that unravel the fascinating world of tech innovation, use case exploration and AI knowledge. Dive into candid discussions with accomplished industry experts and established academics. With each episode, you'll expand your grasp of cutting-edge technologies and ...
…
continue reading
The director’s commentary track for Daring Fireball. Long digressions on Apple, technology, design, movies, and more.
…
continue reading
On The Bike Shed, hosts Joël Quenneville and Stephanie Minn discuss development experiences and challenges at thoughtbot with Ruby, Rails, JavaScript, and whatever else is drawing their attention, admiration, or ire this week.
…
continue reading
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