Unlocking value across the payment continuum. Enhancing performance in a changing healthcare environment

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Barnaby Byrd
7 years ago
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1 Unlocking value across the payment continuum Enhancing performance in a changing healthcare environment

2 For payers, accuracy is business-critical The entire healthcare system is increasingly focused on the delivery of quality care and effective, efficient cost containment. It s an environment that s more difficult to manage by the day. Cotiviti Healthcare: Chart the course to better performance Cotiviti Healthcare s distinct talent is to uncover financial opportunities both before and after payment by: Correctly assigning payer liability Ensuring coding and contract compliance Verifying the clinical appropriateness of claims We have years of experience mining data and spotting patterns and exceptions, with the industry knowledge to fully comprehend the implications of what we find insight that can lead to operational improvement and future savings. Payers play a central role in this transforming landscape. However, there are significant obstacles on the path toward a better system. Coding, compliance mandates, reimbursement models, medical standards and payment policies are more complex than ever. We look more broadly and deeply at claims, eligibility, payments, agreements and policies, using best practices to link everything together and unlock hidden value. We re payer specialists, enabling our clients to prevent erroneous payments when feasible and recover excess compensation when necessary. There s a real need for better accuracy and efficiency that lower administrative and medical costs. If claims and payments do not correctly reflect both the letter and the intent of provider agreements, overpayments can occur and compliance risk can increase, jeopardizing business results. Navigating a complex landscape Throughout the payment cycle, close attention to detail is needed to ensure alignment with provider contracts, medical policies and government regulation. When overpayments happen, payers need to identify the error quickly, find out why it happened and recover funds from providers while minimizing disruption across their network. All of this takes knowledge, insight, and thoroughness. That s where Cotiviti Healthcare can help. Cotiviti Healthcare is not a vendor. They are our partner. They work with us to ensure that we are paying our claims correctly... They respect us, our culture and our providers. LEADING HEALTHCARE PAYER IMPROVING PAYER PERFORMANCE, TODAY AND IN THE FUTURE Cotiviti Healthcare brings together the resources and industry experience of two leaders: ihealth Technologies and Connolly Healthcare. We are a leader in healthcare payment accuracy solutions, saving payers more than $3 billion each year. Cotiviti Healthcare is investing in the future to help payers meet the emerging challenges of a healthcare system in transition. This translates into extensive resources our clients can draw on as they adapt to new realities: Technology-enabled analytics Data mining Clinical competency Practical industry expertise

3 Insight at every step of the way Continuously improving the claims cycle Validating claims throughout the process optimizes the outcome. That s why Cotiviti Healthcare s portfolio spans the payment continuum to yield better results. Meeting your administrative and financial goals can be a real challenge. For every one of the myriad claims you process, you need confidence that you re paying only for what you ve agreed to cover. At the same time, you need to ensure that every regulation and contractual obligation has been met not always an easy task. You have to answer critical questions: Does the claim adhere to regulations, clinical guidelines, payment agreements and your medical policies? Was the claim coded appropriately? Does the billing match the services delivered? Are you liable for payment? Was the patient eligible for coverage at the time of service? Was the claim paid correctly? Do you have the documentation to support recovery of overpayments? Delivering actionable answers The professionals of Cotiviti Healthcare can provide the information you need, across all types of claims and provider service settings, and at the points in the process most appropriate for you. Our solutions are centered on your needs fully customized, comprehensive and based on a collaborative partnership with your team. PROSPECTIVE CLAIMS ACCURACY SOLUTIONS Once a claim is submitted, there s an all-too-brief window to decide whether to accept, reject, or adjust it. That puts a premium on accurate payment policy management. We help you tailor, test and execute best-practice clinical and payment policies, ensuring compliance to avert incorrect payments savings that could add up to millions. Using our medical research skills, coding expertise and industry knowledge, we constantly update our policy library in response to changing regulations and clinical guidelines. Our team leads the industry in payment rules development knowledge that we share with clients to conduct post-adjudication and pre-pay reviews. RETROSPECTIVE CLAIMS ACCURACY SOLUTIONS CLINICAL CHART VALIDATION SOLUTIONS The need to examine large numbers of charts to support claims and ensure compliance can tax the capacity of your systems. Cotiviti Healthcare s technology efficiently handles the volume, helping keep administrative costs under control. Our selection methods further boost efficiency by prioritizing those charts most likely to yield results. Our clinicians, medical directors and coding specialists leverage a comprehensive library of thoroughly researched clinical validation policies to guarantee accuracy. We also apply deep industry knowledge lessons learned serving a broad range of payers, including commercial plans, Medicare Advantage, Medicaid, and CMS. OPTIMIZATION ANALYTICS The Cotiviti Healthcare team always keeps the strong relationship they have with us in mind. They produce excellent results, and the quality of service is very high. FINANCE EXECUTIVE, LARGE HEALTHCARE PAYER When overpayments occur, it s important to identify the reason and recover the funds. In-depth postpay auditing complements pre-pay claim reviews, giving you the insight on how to generate savings and avoid future errors. Our healthcare audit experts use proprietary analytics and data-mining tools to find overpayments that might otherwise go undetected. When we identify an error, we provide your team with full details and supporting documentation, then work closely with you to facilitate recovery all with minimum disruption to your provider and network relationships. Payers are faced with a broad range of issues that can benefit from analytics-based decision making. Our data scientists provide actionable insight into questions of vital importance cost and performance trends, provider and member utilization and the impact of policy change. This information can help identify opportunities for improvement throughout the payment cycle.

4 Committed to your future. Passionate about service. Our professionals are true subject matter experts, able to speak with you peer-to-peer. We re renowned for our close collaborative approach, taking the time to understand your challenges and sharing your drive for better financial results. A culture of innovation Cotiviti Healthcare understands the complex environment created by cost pressure, regulatory mandates and new payment models. We thrive on finding smart solutions to these tough challenges. We re always on the hunt for deeper insights, new concepts to explore, and opportunities to inform and move clients forward. Cotiviti Healthcare is a team in constant motion, dedicated to your long-term success. IRONCLAD PROTECTION FOR YOUR DATA Safeguarding your information is a major imperative for Cotiviti Healthcare, and we make it a priority at the C-suite level. Our Chief Security Officer has one overarching responsibility: protecting client data, through the strategic development and oversight of our robust information security program. Protecting your provider relationships Every recommendation we make recognizes the role your providers play in your success. That s true prior to payment, when we help you optimize your payment policies and assess proposed changes for their impact. It also holds when we pursue overpayments, where we thoroughly research and document our findings to avoid disrupting valuable partnerships. Achieving results, today and for the long term The imperative to hit financial targets and meet high operational expectations, year after year, is why 20 of the top 25 healthcare payers partner with Cotiviti Healthcare. They know our track record of delivering results. We know how difficult it can be to keep policies, agreements and payments aligned in a shifting environment. Years of collaboration with commercial health plans, Medicare, and Medicaid have given us a deep awareness of industry priorities and challenges. We understand your day-to-day pressures and your emerging challenges the importance you place on the bottom line and your administrative issues. That s what produces results. Learn more about how we apply analytics to generate insight and unlock value at cotiviti.com/healthcare. THE COTIVITI WAY Always show respect and care for provider relationships Deliver tangible results Make it easy for the client by taking care of all the details Always do what is right to build long-term relationships Be inventive and in front of change Know the client. Help them succeed and grow.

5 Corporate Headquarters The South Terraces 115 Perimeter Center Place Suite 700 Atlanta, GA cotiviti.com/healthcare All confidential, proprietary information, names and logos contained herein shall at all times be and remain the sole and exclusive property of 2015 Cotiviti Corporation and its wholly-owned subsidiaries.

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