What a Denied Claim Actually Costs
Every billing and coding leader has a sense of what denied claims cost. What is less commonly understood is how much the cost varies by denial type, how sharply it has […]
What Makes the NPD Work: Credit Where It Is Due
Last week, I wrote about the historic arrival of the National Provider Directory on April 9. This week I want to be more specific about what the NPD delivers, because […]
The $125 Billion Problem: Where Bad Provider Data Enters the Revenue Cycle
In Bad Provider Data Costs Billing Firms More Than You Think, we established the scale of the problem. Now we trace it. Because understanding where bad provider data enters the revenue cycle is the […]
Bad Provider Data Costs Billing Firms More Than You Think
If you run a billing and coding operation, you already know that denied claims are expensive. What many revenue cycle leaders underestimate is how much of that expense traces directly […]
The Build-vs.-Buy Fallacy: Why Internal Provider Data Projects Keep Failing, and What to Do Instead
If your organization has spent the last several years working on a provider data project (building internal pipelines, layering on vendors, or trying to designate a system of record), you […]
Why the $21B Automation Opportunity Starts With Provider Data – Not Technology
The healthcare industry has been talking about automation for decades. The 2025 CAQH Index quantified just how much progress has been made: an estimated $258 billion in administrative costs avoided through electronic transactions and […]
The Stars Are Watching: How Provider Data Accuracy Flows Through to MA Quality Ratings and Revenue
In Medicare Advantage, a plan’s Stars rating isn’t just a quality scorecard. It’s a financial instrument. Plans that earn four or more stars are eligible for quality bonus payments and […]
Auto-Adjudication Is a Provider Data Problem in Disguise
There’s a familiar moment in health plan operations: a claim enters the system, moves toward auto-adjudication and then stops. Something didn’t match. A manual reviewer picks it up. The queue […]
The Hidden Tax on Your Revenue Cycle: What Provider Data Errors Actually Cost
Most health plans track denial rates. Very few have calculated what bad provider data specifically costs them across the full revenue cycle, from the first claim submission through rework, appeals, […]
Why Data Drift is Inevitable Without Continuous Validation– And Why Cleanup Will Never Be Enough
This is part of a continuing series on provider data, compliance, and the revenue cycle Previous articles in this series: When Your Provider Directory Becomes Public Infrastructure | The REAL […]