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Mark Cuban Is Right About Transparency. He's Looking at the Wrong Side of the Ledger

Mark Cuban Is Right About Transparency. He's Looking at the Wrong Side of the Ledger

A Capital Pulse perspective

On a recent episode of KFF Health News' What the Health? podcast, Mark Cuban made a pointed claim, later covered by Becker's Hospital Review. He argued that many U.S. hospitals don't really know what their services cost. Instead of building a true bill of materials for a hip replacement, they spread costs across services using broad cost-to-charge ratios. In his view, many hospitals "just know their cash balance."

Cuban is right that transparency is the cure for much of what ails healthcare finance. But for the hospital CFOs we work with, the most dangerous unknown isn't what a service costs to deliver. It's when — and whether — they'll be paid for it. Here's how we see it.

1. You can't efficiency your way out of a 90-day claim

Granular cost accounting is a worthy goal. But knowing the exact unit cost of a knee replacement doesn't make Aetna or Medicaid pay the claim in 48 hours instead of 90 days.

A hospital can optimize its supply chain and labor down to the penny and still operate on a median margin of roughly 2% (Kaufman Hall, National Hospital Flash Report, January 2026). It does so inside a transactional framework where payers routinely delay, adjust, or deny claims without warning. At those margins, the timing and certainty of revenue matter at least as much as the precision of cost. Operational efficiency can't compensate for a revenue stream the hospital doesn't control.

2. Managing by cash balance is rational, not negligent

Cuban treats cash-balance management as a symptom of hospitals failing to run like real businesses. We'd argue it's the opposite. It's what a disciplined operator does under extreme revenue uncertainty. The problem is a gap between what a hospital ought to be paid and what it will be paid:

  • Revenue cycle management (RCM) software is a scorekeeper. It tells a hospital what it ought to collect under its contracts.
  • RCM cannot tell a hospital when, or if, that money will actually arrive.
  • Because claims behave like opaque IOUs, with reimbursement lags of 30 to 120 days, hospitals hold enormous defensive cash reserves. The median rated nonprofit carries about 212 days of cash on hand (Fitch, fiscal 2025). Even the weaker half of S&P's rated hospitals holds roughly 128 days, and the small, rural, and safety-net hospitals most exposed to payment delays often don't appear in rating-agency data at all.

That cash cushion isn't a failure of management. It's insurance against a system that makes revenue unpredictable. Any business in any industry facing the same uncertainty would do exactly the same.

3. Transparency belongs inside the claim

Cuban calls for radical price transparency and publicly available employer contracts. We agree transparency is the answer. We apply it where hospitals feel the pain most directly: in the value of the claim itself.

Retrospective accounting reports tell a hospital what already happened. Capital Pulse applies statistical learning and natural language processing to the raw 837 and 835 EDI files that document every claim and remittance. From that data, our models predict actual claim outcomes (payment probability, timing, and denial risk) with ~95% accuracy. That turns a claim from an opaque IOU into a measurable asset. The hospital knows not just what it's owed, but what it will collect, and when.

4. The information asymmetry runs through the payer relationship

Cuban rightly criticizes the confidentiality clauses that keep healthcare contracts hidden and prices distorted. From the billing side, the asymmetry is just as stark, and it starts with price:

  • Commercial prices vary widely. Commercial insurers paid hospitals an average of 254% of Medicare rates for the same services at the same facilities. That ranged from under 170% in Arkansas to more than 300% in eight states (RAND, 2022 data).
  • Denials cost providers more every year. Fighting denials cost providers more than $25.7 billion in 2023, a 23% jump in a single year (Premier, 2025). Payers initially denied nearly 15% of claims, and in some cases as many as 49%.
  • Most of those denials shouldn't have happened. About 70% of denied claims were ultimately paid. That means roughly $18 billion was spent arguing over claims that should have been paid on submission.
  • Even pre-approved care gets denied. In 2023, 10.4% of denied claims had already been approved through prior authorization, up from 3.2% the year before.
  • The delays are long. Providers went through an average of three rounds of review per denied claim, and each round took 45 to 60 days.

Do the math on that last point. A claim that should have been paid at submission can sit in dispute for four to six months before the money arrives. That's not a pricing problem or a cost-accounting problem. It's a visibility problem. Payers see denial and payment patterns across thousands of providers, while most hospitals see only their own claims, one dispute at a time.

Cuban himself argues that hospitals should count denials, payment delays, and clawbacks when deciding whether a payer relationship is profitable. We agree, and that cost can now be measured. Capital Pulse's analytics detect systematic underpayments and denial patterns across a hospital's claims, giving providers the data they need to negotiate commercial contracts from a position of evidence rather than anecdote.

5. Not every hospital can pivot like a startup

Cuban says that if he bought a hospital, he'd run it like a startup and compete to win patients. That's a compelling vision for a system with the freedom to reshape its service mix and payer mix.

Safety-net and rural community hospitals don't have that freedom. They serve high Medicare and Medicaid populations because that's who lives in their communities. What they do have is a large, reliable, and chronically undervalued asset: government-backed receivables.

Capital Pulse's Healthcare Claims Scoring System (HCSS) translates a hospital's claims portfolio into standardized, bankable assets. Because those receivables are backed by payers of the highest credit quality, hospitals can monetize their A/R through a full-value, non-recourse true sale coupled with an up-front cash advance at highly efficient rates. The result converts "payment eventually" into same-day working capital, without adding debt to the balance sheet.

Transparency, down to the day

Cuban wants hospitals to know their costs down to the penny. We want them to know their cash, down to the day. Both are forms of transparency. But only one of them makes Friday's payroll.


*Capital Pulse uses AI-powered predictive analytics to convert medical receivables into working capital. To learn more about how same-day reimbursement can transform your organization's cash flow, visit capitalpulse.com or contact our team.*

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