By Rafiq Ahmed – For decades, one of the most consequential numbers in healthcare was effectively invisible to the providers delivering care: what a payer actually reimburses a hospital for a given service. Health systems negotiated contracts based on internal assumptions, historical precedent, and incomplete intelligence about what the market was actually paying.
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By Tyler Cobb – A certificate of insurance is a one-page summary issued as a convenience. It is not a policy, it confers no rights, and it says almost nothing about whether the endorsements behind it actually match what the contract requires. Third-party risk has become a primary exposure pathway for provider organizations.
By Jerry Smith – Drug affordability conversations often center on manufacturers and their high list prices. This focus overlooks the real cost driver: the complex pharmaceutical ecosystem.
By Megan Schmidt – Healthcare is spending billions to modernize the future while ignoring one of its most expensive operational failures. Provider data, the foundational information that determines who gets paid, where patients receive care, and how networks function, remains inaccurate across much of the industry.
Reported payers and health insurance industry news from UnitedHealthcare, RevSpring, PatientGenie, Anthem Blue Cross and Blue Shield, CareFirst BlueCross BlueShield, Aetna, GoHealth and more.
By Michael Ford – A growing share of the problem hospitals face today doesn’t come from denials at all. It comes from claims that sit unresolved without ever receiving a formal denial. Why do these claims fall through the cracks?
By April Miller – Healthcare organizations face financial pressure as operating costs and administrative demands increase. At the same time, patients expect clear pricing and greater transparency throughout the billing process.
By Dana Finnegan – Inpatient denials have long dominated health system revenue integrity efforts. Yet a surge in outpatient and ambulatory care coding errors and documentation gaps now threatens revenue, often slipping under the radar and creating significant new risks.
By Peter Justen – Hospitals across the country are facing mounting financial pressure, particularly in rural communities where margins are already thin and access to care is increasingly fragile. Rising uncompensated care, growing administrative complexity, and continued Medicaid uncertainty are placing additional strain on systems already operating with limited resources.