What's New

As 2023 closes, we look back on an exciting year as we continue to unlock unique Payment Integrity solutions for our customers, increasing efficiencies and delivering value with integrity.

What has been the most important achievements this year for Cotiviti?

Ancillary Compliance: To see Gamma disrupting Ancillary leakage and delivering value in both the AU and US market has been a major highlight for Cotiviti.

We are excited to announce that, our customers on Gamma are experiencing notable cost savings through both recovery and changes in claiming behaviour.

In addition, we are proud to announce that we are now live with Cotiviti's fully outsourced model for Ancillary Compliance. In this model Cotiviti’s Audit Specialists provide end-to-end services on behalf of our customers including identifying providers with inappropriate claiming patterns, provider communication, follow up and debt collection where applicable.

This allows funds to focus on their core operations.

Cotiviti looks forward to working with more funds in 2024 to help combat Ancillary leakage.

Custom Statuses: Creating new ways to increase accuracy within HIBIS with the launch of Custom Statuses has been another standout. This feature has enabled our customers to customise the Alert Statuses in their HIBIS instance to reflect their unique workflow.

This helps the users to accurately record their savings in HIBIS, allowing Cotiviti to optimise the rule content for better accuracy.

Additionally, Custom Statuses makes it easier for auditors to monitor the progress of an alert and helps to prevent unnecessary duplication in reporting.

Customer Forum: Hosting you all and bringing together our customers from across Australia to discuss new ways to enhance payment integrity outcomes, explore innovative ways to leverage the powerful perspectives that healthcare data provides, was certainly a highlight of our year.

As your trusted Payment Integrity Partner, we pride ourselves in developing innovative solutions to tackle emerging challenges in the ever-evolving healthcare landscape.

What's in store for you in 2024:

Cutting-Edge Analytics: Artificial Intelligence & Machine Learning

We are investing heavily in AI and ML technologies to move beyond rule based systems to create innovative solutions and increase savings under our Services Model. Our team of experts is dedicated to harnessing the power of data-driven insights to unlock new value and reduce your funds claims leakage.

Accurate and Actionable Insights: A Comprehensive Approach to Claims Assessment

We understand that accurate insights are crucial for making informed decisions. That's why we are enhancing our approach to claims assessment to enable comprehensive evaluation of claims at multiple levels, from individual claims to the aggregated provider level. This ensures accurate findings, reduces provider abrasion and drives positive change for your Payment Integrity practices.

Innovative Solutions: Hospital Audit Solution & Medical Compliance Solution

As the healthcare landscape evolves, so do our solutions. We are continuously developing new offerings that address the unique challenges faced by the industry, from targeted and streamlined hospital audits to detecting non-compliance in medical claims with high efficiency. We look forward to moving these concepts into solutions in the coming year.

Stay tuned for updates as we unveil new features, share success stories, and showcase how Cotiviti is transforming Payment Integrity in 2024.

Our teams are constantly striving to increase value generated via our Ecosystems.

In the past 12 months, our analytics team has been busy implementing cutting-edge AI and ML techniques to expand the coverage of Fraud, Waste and Abuse (FWA) captured by our compliance solution suite.

These advanced techniques have helped to uncover suspicious patterns and emerging trends previously unknown to the industry. With collaborative input from the clinical and coding experts within our US business, these initiatives have proven immensely successful for Cotiviti's US clients.

We are eager to extend and replicate this success for our Australian customers in 2024.

Our Payment Integrity Team now have expertise in the following areas:

• Health Information Managers
• Clinical Coders
• Registered Clinical Nurses

Introducing Recommendations:

Our PIP team understands the importance of ensuring accurate payments, and our team is committed to helping you achieve just that.

By combining our extensive experience with innovative technology, we will continue to set new standards in Payment Integrity delivering our newest service model, Recommendations.

Our team of experts will dive deep into your fund's alerts and deliver actionable Recommendations for you to investigate.

With Recommendations, you can expect:

• Smoother workflow
• Significant reduction in false positives
• Improved efficiency

And guess what? Since its implementation, Recommendations has delivered findings with an accuracy exceeding 80%. That means, you save time with accurate Recommendations, to feel empowered to take action.

Onsite Audit Services:

Cotiviti's PIP team provides on-site medical record reviews to ensure that documentation supports the coding and billing submitted to the fund.

Our PIP team will work with you to devise and agree on the specific audit program, including areas of focus, sample size and mode of audit. Focus areas can include:

• Certificate review (including acute care, ICU/CCU, rehabilitation, Type B/C certification)
• DRG and clinical coding review
• Prosthesis review
• Theatre review
• Intensive care and special care unit

If you have any questions or would like to explore how the PIP team can support your funds Payment Integrity Strategy, please reach out to customer-experience@cotiviti.com.