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 […]
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 Inaccurate Provider Data Enters the Revenue Cycle
In Inaccurate 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 […]
Inaccurate 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 […]