Overheard at AcademyHealth: Health Policy, Social Determinants, and Data

Jordan Bazinsky, executive vice president and administrative officer for Cotiviti, breaks down various factors impacting innovation, including market trends that he believes are both headwinds and tailwinds to innovation, as well as shares a framework based on what’s happening in the current health care landscape.

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Regulatory, Structural Trends Impacting Innovation for Payers

Addressing the Complexities of Value-Based Payment Models

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.

From the Trenches

Episode 18 - The insider's guide to clinical appropriateness

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 jeffrey.robinson@cotiviti.com.

Episode 18 - The insider's guide to clinical appropriateness

Cotiviti

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