Credentialing Gaps and Billing Failures: The Connection Most Billing Firms Are Missing
Most organizations treat credentialing and billing as two separate processes. In practice, they are directly dependent. Credentialing verifies that a provider is qualified and enrolled. Billing submits claims for the […]
The Layer Underneath: How Payers Can Get NPD-Ready
The last few articles I have written have been about the problem MA plans are facing: what the NPD is, what it is not, what Phase 2 does to the […]
The Performance-Based Contract Trap: How Provider Data Errors Hit Billing Firm Revenue Directly
Most billing and coding contracts are written to reward performance. Clean claim rates, first-pass acceptance rates, net collection rates, days in accounts receivable: these are the metrics that determine what […]
September 1, 2026: The Attestation Deadline No MA CEO Can Afford to Miss
If you are the CEO, CFO, or COO of a Medicare Advantage organization, you are going to personally sign something in less than four months. I want to make sure […]
Taxonomy Codes, Network Status, and the Invisible Denials That Are Costing You Revenue
If NPI errors are the most visible provider data failure in billing operations, taxonomy code mismatches and outdated network status information are the most insidious. They generate denials that look […]
The NPI Problem: Why One Wrong Number Cascades Into Thousands of Denied Claims
Of all the provider data fields that drive claim denials, the National Provider Identifier is the most consequential. An NPI error does not produce one denial. It produces a pattern […]
Phase 2 Changes Everything: Why 2027 Is the Real Inflection Point
If you are a payer executive and you have been treating the April 9 NPD launch as the main event, I want to respectfully suggest otherwise. The main event is […]
Why Your Clean Claim Rate Is a Provider Data Problem in Disguise
Billing and coding organizations invest heavily in clean claim rates. Quality checks, claim scrubbers, staff training, coding certification, all designed to maximize the percentage of claims that pass through without rejection […]
What the NPD Was Built to Do (And What Still Needs Doing)
I have been writing about the April 9 release of the National Provider Directory, and I have been explicit about giving CMS credit for getting it done. This week, I […]
Inside the Staffing Crisis: How Provider Data Errors Drain Your Team
The 2025 State of Claims survey from Experian Health found that 43% of healthcare organizations report insufficient staffing in revenue cycle operations. That figure has become a fixture in industry […]