Reviewing clinical charts to validate that key diagnoses and procedures on claims are properly supported is costly and time-consuming. When payers concentrate on reviewing as many charts as possible, they waste time and resources while risking their provider relationships addressing overpayments with a low return on investment. In addition, although coding errors and documentation issues are important to catch, they don’t always add up to high-dollar overpayments.
Cotiviti’s Clinical Chart Validation solution goes beyond coding and documentation review with a comprehensive prospective and retrospective solution that reduces unnecessary provider requests and keeps costs sustainable.
Save up to 4 percent or more on annual DRG, short stay, and readmissions spend
Isolate charts with the highest probability of overpayment
Catch higher-value errors that others miss with coding, documentation, and clinical validation
Minimize provider abrasion with direct physician involvement in chart reviews
Catch more overpayments prospectively by reviewing more than just the highest-dollar claims
Cotiviti is the only vendor to provide a comprehensive program of prospective and retrospective claim reviews of inpatient DRGs, short stays, and readmissions. Our industry-leading team uses machine learning to help isolate charts with the highest probability of overpayment, while deeper analysis—combining coding, documentation, and clinical chart reviews—reveals higher-value errors that others miss. We drive better results through:
Cotiviti’s team has real-world experience and possesses a deep, inherent understanding of evidence-based medical literature and its connection to proper claims coding. Led by a team of full-time physician medical directors, our auditors are registered nurses and credentialed coding experts with an average 20 years of clinical experience.
Our team operates in a culture of continuous learning, and is dedicated to accommodating unique client requirements and delivering reliable results. Before they conduct their first chart review, auditors must complete our rigorous onboarding and training process accredited by AAPC. We further require them to complete monthly education sessions to hone their skills and keep audit sustainability, quality, and consistency high.
Cotiviti delivers a real and positive impact on selection rate, change rate, and sustainability rate. Direct physician involvement in reviews and appeals sets Cotiviti apart. Applying best practices, clinical insight, and intelligence from chart review through claim resolution, our medical directors conduct research, direct protocol reviews, and handle provider consultations on your behalf, physician to physician. Going beyond the standard rules of correct coding, our auditors consult with provider medical directors to review why particular claims were changed, fostering engagement while reducing the likelihood of a poor provider experience.
Average savings of 4 percent on DRG, short stay, and readmissions spend
30 to 35 percent average change rate of retrospectively reviewed charts
70 percent or higher change rates expected for prospectively reviewed charts*
80 percent or higher chart receipt rates expected for prospective program*
96 percent sustainability rate of audit findings
600,000+ medical charts reviewed in the last year