Healthcare can record every detail and still lose the plot. Before we buy more AI, we should ask why our systems keep forgetting what they already know.
“Is there an economic or operational impact that’s going
to translate to dollars?” — Nassib
Chamoun, founder and CEO of the Health Data Analytics Institute, at the
HIMSS AI in Healthcare Forum
That is an excellent question for healthcare AI. It is also
an uncomfortable question for the companies selling it.
A model can impress in a demonstration. A chatbot can
produce a convincing answer. An automation platform can complete a task in
seconds.
But did the technology improve the outcome? Did it eliminate
unnecessary work? Did it make the process more reliable? Did the financial
benefit exceed the cost of implementation and maintenance?
Or did we simply teach the existing problem to move faster?
In medical billing, that last possibility deserves more
attention than it gets.
A Man Survived a Heart Attack. Then He Had to Reconstruct
His Own Story.
In December 2025, Amritpal Virdee was rushed to Midland
Metropolitan University Hospital in England after suffering a life-threatening
heart attack.
Doctors inserted a stent to restore blood flow to his heart.
But his condition deteriorated. His heart stopped for several minutes, and he
was admitted to the intensive care unit.
For a period of his recovery, much of his experience was
missing from his memory.
While Amritpal was sedated, nurses documented his journey in
an ICU diary. They recorded medical developments, family visits, conversations,
and ordinary moments that might otherwise have disappeared.
His wife, Pam, and son, Ruben, were part of that journey. So
was a visit from his brother.
During the visit, a nurse turned on the television so the
brothers could watch the news and Match of the Day. The team discovered
that Amritpal supported Newcastle United.
It was a small detail in an extraordinary situation.
Yet it helped preserve something a medical chart alone might
not have conveyed: the person behind the patient.
When Amritpal later read the diary, he could begin to piece
together what had happened while he could not remember it. He could understand
not only the medical events but also the care, attention, and human moments
surrounding them.
Catherine Beddowes, Senior Sister for Critical Care Follow
Up Support at Midland Metropolitan University Hospital, explained that ICU
diaries can preserve both medical milestones and personal details that help
patients make sense of their experience.
Amritpal expressed his gratitude to the staff and doctors
who cared for him.
The hospital published his story on October 23, 2026.
The lesson is not that a diary is a substitute for a medical
record. It is that recording information and preserving its meaning are two
different things.
Sometimes, caring for someone means remembering the
things they cannot.
Now consider a very different setting.
A physician finishes seeing patients. The clinical work is
done. The documentation is in the EHR. The billing team submits the claim.
Weeks later, someone discovers a problem.
An authorization number cannot be found. A payer requests
additional information. A claim is denied. A staff member opens the EHR, checks
the clearinghouse, searches email, logs into a payer portal, and asks a
colleague whether anyone remembers what happened.
The question is familiar:
“Does anyone know what happened with this claim?”
No ICU alarm sounds. Nobody is fighting for their life. The
consequences are not comparable to Amritpal’s medical emergency.
But the operational question is worth asking:
Why does healthcare repeatedly have to reconstruct
information that should already be available?
In critical care, a diary helped a patient reconnect with
his experience.
In medical billing, better operational memory could help a
practice reconnect the dots between an encounter, the information supporting a
claim, the actions already taken, and the work still required.
Different circumstances. Different stakes. One useful
systems question: are we preserving information in a form that helps people
understand what happened and decide what to do next?
Healthcare Has a Memory Problem. It Just Calls It an
Administrative Expense.
Imagine a highly experienced medical biller.
She knows which payer requires an additional document. She
remembers which physician routinely misses a particular field. She knows where
the authorization number is usually stored, which claims need attention before
Friday, and which payer representative might actually answer the phone.
Her knowledge is valuable.
But how much of it exists in the system—and how much exists
only in her head?
She may use an EHR, a practice management system, a
clearinghouse, payer portals, spreadsheets, email, and a collection of notes.
Each tool has a purpose. The problem emerges between them.
The authorization is in one place. The appointment is in
another. The claim is somewhere else. The reason a staff member made a
particular decision may be buried in an email from three weeks ago.
Our biller knows how the pieces fit together because she has
spent years learning the exceptions.
She is not merely processing claims. She is compensating for
the architecture.
Now imagine she takes two weeks off.
Suddenly, the practice discovers that its operating manual
has been walking around wearing comfortable shoes.
The system may contain most of the information. It simply
does not preserve enough of the context to make that information easy to use.
This is the hidden cost of fragmented operations.
The most expensive information in a medical practice may
be the information everyone assumes someone else remembers.
The consequences include repeated searches, duplicate work,
delayed follow-up, unclear ownership, and avoidable errors. Some work is
necessary. Payer requirements can be complex, and legitimate exceptions will
always exist.
But there is a difference between doing necessary work and
repeatedly rediscovering information because the system failed to make it
available.
The first is part of healthcare administration.
The second is digital archaeology.
The tools are digital. The excavation is manual.
The Contrarian Argument: More Automation Is Not Always
More Progress
The usual pitch for healthcare technology is
straightforward:
Find a repetitive task. Automate it. Save time.
Repeat until the practice becomes more efficient.
There is nothing wrong with this approach when the task is
necessary, the automation is reliable, and the results are measurable.
The problem is the assumption underneath it: that the work
being automated should exist in the first place.
Imagine a claim is denied because authorization information
was not attached correctly.
One solution is to automate the process of finding the
authorization number and attaching it to the claim.
That might help.
But what if the real problem is that the authorization was
never connected to the relevant service? What if nobody owned the handoff? What
if the information was captured in a system that the billing workflow could not
access? What if the number was present but its scope or validity had not been
verified?
Automating the final step might address the symptom while
leaving the underlying failure untouched.
Congratulations. We have industrialized the workaround.
The same pattern appears in many business processes.
Organizations add a dashboard to monitor a spreadsheet, then automate the
spreadsheet, then build an alert to warn staff when the spreadsheet is wrong.
Eventually, someone asks whether the spreadsheet was solving
the right problem in the first place.
Healthcare is not immune to this cycle.
The issue is not that automation is bad. It is that
automation can make a poorly designed process more efficient at producing
unnecessary work.
A useful principle from management thinker W. Edwards Deming
is to examine the system in which people work rather than automatically blaming
individuals for recurring failures.
If staff repeatedly miss the same step, training may help.
But if the process hides critical information, leaves responsibility unclear,
and offers no warning before submission, training alone may not solve the
problem.
The person who touches the claim last is not necessarily the
person—or system—that created the failure.
Before automating a task, ask three questions:
- Is
this task necessary?
- Why
does it exist?
- What
would prevent the underlying problem from recurring?
The goal is not to make people better at working around
broken systems. It is to need fewer workarounds.
That is a much more interesting AI problem.
A Claim Is Not an Isolated Transaction. It Is the Ending
of a Story.
Medical billing is commonly divided into functions:
eligibility verification, referral management, prior authorization,
documentation, coding, claim submission, payment posting, denial management,
and appeals.
Those functions matter. But treating them as isolated
activities can obscure the larger picture.
A claim is the financial expression of a clinical and
administrative journey.
Consider the sequence:
Patient → Insurance → Eligibility → Referral →
Authorization → Encounter → Documentation → Coding → Claim → Payer → Payment →
Denial or Exception → Resolution → Feedback
Every stage can create information the next stage needs.
An authorization is not just a number. It has context:
patient, service, provider, payer, date, and applicable conditions.
A clinical note is not just a document. It supports the
medical record and may support the services billed, subject to applicable
documentation, coding, and payer requirements.
A denial is not just a negative payment outcome. It is
evidence about a transaction that needs to be understood.
The system should preserve the relationships among these
pieces of information.
Otherwise, the practice receives fragments and must
reconstruct the story.
Think of a claim arriving at the end of the process like a
stranger carrying a stack of papers and announcing, “I believe you owe me
money.”
The billing team has to investigate who the stranger is,
what happened, whether the paperwork is complete, and whether the request is
valid.
That is not a particularly efficient way to run a revenue
cycle.
A more reliable process makes it possible to trace how a
claim came to exist, which information supported it, what requirements applied,
which actions were completed, and what remains unresolved.
This is the difference between storing data and preserving
operational context.
Data answers: “What information do we have?”
Context answers: “What does this information mean for this
case?”
Operational memory answers: “What happened, who did what,
why did they do it, and what needs to happen next?”
That final question is where the opportunity lies.
The Denial Is the Crime Scene, Not Necessarily the Crime.
A denial is visible. Its cause may not be.
When a claim is denied, the practice reviews the reason,
checks documentation, investigates the payer's decision, and determines whether
to correct, appeal, or write off the claim.
That work is often necessary.
But the denial may be the last visible symptom of an earlier
failure.
Perhaps eligibility was checked too early and not reverified
after a change. Perhaps a referral was received but never connected to the
appointment. Perhaps an authorization was obtained but not associated with the
service. Perhaps the documentation was complete but the claim contained a
mismatch.
Or perhaps the payer made an error despite the practice
having followed the applicable requirements.
These causes are different. They require different
responses.
A useful system should not treat every denial as proof that
the practice made a mistake. Nor should it assume that every denial is the
payer's fault.
The better question is:
At what point did the conditions for a successful claim
stop being true—and what evidence supports that conclusion?
That changes the work.
Instead of repeatedly correcting individual claims, the
practice can identify patterns, investigate root causes, and determine which
failures can be prevented.
A recurring eligibility problem might call for a change in
verification timing.
An authorization problem might require better tracking of
scope, expiration, or service matching.
A payer-specific pattern might require a contract review or
a documented escalation strategy.
A documentation issue might require clinician education or a
better information-capture process.
A system defect might require a technical change.
The correct response depends on the evidence.
The faster the practice can identify a recurring failure,
the less time it spends rediscovering the same lesson.
The objective is not to eliminate every exception. It is to
stop treating every exception as if it were the first one ever encountered.
The Human Cost of Reconstructing Information
Fragmented information affects more than the billing
department.
A physician may be asked to clarify documentation long after
the encounter.
A front-desk employee may repeat an eligibility check
because the previous result cannot be found or trusted.
A billing specialist may spend time locating information
another team member already collected.
A patient may receive an unexpected bill while the practice
investigates an unresolved payer issue.
A practice owner may see revenue delayed without knowing
whether the cause is payer behavior, an internal process failure, or both.
The American Medical Association's prior authorization
survey, reported in May 2026, illustrates the broader administrative burden.
The survey found that physicians reported an average of 40
prior authorization requests per week, consuming an average of 13 hours of
physician and staff time. Ninety-five percent said prior authorization delayed
access to necessary care, while 94% said it contributed to physician burnout.
These findings concern prior authorization specifically.
They should not be misrepresented as measurements of all billing inefficiency.
But they raise a relevant question for independent
practices: how much administrative effort is unavoidable, how much is driven by
external requirements, and how much is caused by the way information and
responsibility are organized internally?
A practice cannot eliminate every payer requirement.
It can investigate whether its own systems make compliance
harder than necessary.
That distinction matters. It prevents practices from blaming
themselves for problems they cannot control—and from overlooking problems they
can fix.
Healthcare Is Buying More AI. Is It Getting More Value?
On October 23, 2026, MobiHealthNews reported on a HIMSS AI
in Healthcare Forum discussion about measuring AI by adoption, outcomes,
operational performance, and cost.
Nassib Chamoun, founder and CEO of the Health Data Analytics
Institute, posed the question featured at the beginning of this article: is
there an economic or operational impact that translates to dollars?
The point is important because technical performance is only
one part of the equation.
A system can perform well in a test environment and still
struggle in daily operations. Integration takes time. Staff need training. Data
may be incomplete. A tool may require ongoing maintenance. A workflow may be
technically automated but still require substantial human intervention.
The demo is not the business outcome.
For an independent clinic, the right questions include:
- Has
the number of manual touches per claim declined?
- Is
less time spent searching for information?
- Are
avoidable corrections decreasing?
- Are
recurring errors being prevented or merely processed faster?
- Can
staff identify the next action without opening several systems?
- Does
the benefit justify implementation, maintenance, and oversight costs?
A practice could adopt five new tools and still require
staff to copy information between them, reconcile conflicting records, check
multiple portals, and determine which system contains the authoritative answer.
The technology inventory would look impressive.
The employee's day might look exactly the same.
That is why a better question is not, “How much of our
revenue cycle have we automated?”
It is:
“How much unnecessary work has disappeared?”
That is the measure that matters.
Three Perspectives That Challenge the Status Quo
Atul Gawande: Expertise Needs Reliable Systems
In The Checklist Manifesto and Better, surgeon
and writer Atul Gawande explored how structured practices can help
professionals manage complexity and improve reliability.
The lesson is not that healthcare workers should be replaced
by checklists or software.
It is that expertise alone is an unreliable substitute for
systems that make critical information and steps consistently available.
A highly experienced biller may know how to handle a
difficult claim. But the organization should not need that person's memory to
rediscover the same requirements every time a similar case appears.
Practical implication: Make important steps visible,
make exceptions explicit, and preserve the information needed to repeat
successful work.
W. Edwards Deming: Fix the System, Not Just the Last
Person in the Chain
Deming's work on quality management emphasized improving the
system in which people work.
Applied to medical billing, that means examining recurring
failures as patterns rather than treating every one as an isolated staff error.
If authorization information repeatedly fails to reach the
billing team, another reminder email may not be the answer.
Investigate the handoff.
Who owns the information? Where is it recorded? How does the
next person know it is complete? What happens when the information is missing
or inconsistent?
Practical implication: Measure recurring failures,
identify their causes, and redesign the conditions that produce them.
Nassib Chamoun: AI Needs to Prove Its Value
Chamoun's October 23 comments at the HIMSS AI in Healthcare
Forum emphasized the need to look beyond model performance to operational and
economic impact.
For an independent practice, that is a useful standard. A
tool is not valuable simply because it uses AI, offers an impressive interface,
or completes a task quickly.
It is valuable when it solves a real problem at a cost and
risk the practice can justify.
Practical implication: Evaluate technology against
measurable outcomes, not feature lists or marketing claims.
Together, these perspectives point toward a common
principle:
Reliable operations require capable people, useful
technology, and a system that preserves information, clarifies responsibility,
and makes the next appropriate action visible.
A Record Is Not the Same Thing as a Memory
Let us return to Amritpal's ICU diary.
The nurses did not simply collect disconnected observations.
They preserved a sequence of events in a form that helped him understand his
experience later.
The diary connected details to a timeline and a human
context.
Medical billing needs a different kind of operational
record, but the principle is relevant.
A folder containing an authorization, a clinical note, a
claim, a remittance advice, and an appeal letter may contain all the necessary
information. Yet a staff member may still have to determine how those documents
relate to one another.
A useful operational system should help answer:
- What
happened?
- When
did it happen?
- Who
was responsible?
- What
information supported the action?
- Which
requirement or policy applied?
- What
remains unresolved?
- What
is the next action, and by when?
- If the
decision is challenged, can the practice reconstruct the reasoning?
That last question becomes especially important as AI enters
revenue-cycle operations.
It is not enough for a system to produce an answer. The
practice needs to understand the basis for consequential actions, verify the
supporting information, correct mistakes, and determine who is accountable.
A confident answer without a traceable basis can create a
new problem while appearing to solve an old one.
Healthcare does not need automation that merely sounds
certain.
It needs automation that can show its work.
The Next Generation of AI Should Not Just Answer
Questions. It Should Help Finish Work.
Much of the public conversation about AI focuses on chat
interfaces, generated text, summaries, and faster responses.
Those capabilities can be valuable.
But a medical practice does not collect revenue because
someone wrote a clever paragraph about a denial.
Revenue-cycle work requires a sequence of connected actions:
identify the problem, retrieve relevant information, check applicable
requirements, determine the next appropriate step, route the work to the right
person, and verify that the outcome occurred.
A system that identifies an authorization mismatch but
leaves the staff member to locate the authorization, determine ownership, set a
reminder, and follow up has solved only part of the problem.
A more useful system would connect detection to action while
preserving appropriate human oversight.
For example, imagine a claim-preparation process that
identifies missing information before submission.
Instead of merely displaying an error, the system could
identify the missing item, locate relevant existing records where authorized,
explain what remains unverified, assign the issue to the appropriate role, and
track its resolution.
If the information cannot be confirmed, the system should
say so.
If the situation requires clinical judgment, payer
interpretation, or human approval, the system should escalate rather than
improvise.
If an automated action occurs, the practice should be able
to inspect what happened and why.
This is not a promise that every claim can be made
error-free or every denial eliminated. Payers make decisions, rules vary,
clinical circumstances differ, and some disputes are unavoidable.
It is a different definition of progress.
The objective is not to automate the appearance of work.
It is to reduce the amount of work required to reach a reliable outcome.
That is where AI can move beyond being another interface and
become a meaningful part of operational infrastructure.
A Practical Plan for Independent Practices
A practice does not need to rebuild its entire technology
stack to start improving information flow.
It needs to identify where information is lost, where work
is repeated, and where responsibility becomes unclear.
Step 1: Choose One Painful Process
Do not begin by attempting to automate the entire revenue
cycle.
Choose one recurring problem, such as eligibility
verification, authorization tracking, missing documentation, claim-status
follow-up, or denial resolution.
Select a process with enough volume to measure but a
manageable scope.
A narrow pilot makes it easier to identify whether a change
actually improves performance.
Step 2: Map What Really Happens
Document what staff actually do—not merely what the
procedure manual says they do.
Where is information captured? Which systems are consulted?
When is information copied manually? Who owns each step? What happens when a
required item is missing?
Where do staff rely on memory, informal messages, or
personal relationships to move work forward?
The purpose is not to criticize staff. It is to reveal the
hidden work required to keep the process functioning.
Step 3: Establish a Baseline
Measure the process before introducing a new tool.
Useful measures include:
- Manual
touches per claim.
- Time
spent locating or reconciling information.
- Percentage
of claims requiring avoidable correction.
- Denial
rate by category and payer.
- Days
in accounts receivable, interpreted alongside payer mix and contract
terms.
- Time
from identifying an exception to resolving it.
- Percentage
of tasks with clear ownership and a documented next action.
Do not assume every denial is preventable. Separate
payer-driven, coverage-related, documentation-related, coding-related,
eligibility-related, and other causes where the available evidence supports
those categories.
A useful baseline distinguishes what the practice can change
from what it cannot.
Step 4: Fix the Information Handoff
Before buying more software, ask whether existing systems
can preserve the necessary information and make it available to the next
person.
Can authorization details be linked to the relevant
appointment or service?
Can claim status and follow-up responsibility be made
visible?
Can staff see which information is confirmed, missing,
outdated, or conflicting?
Can the practice establish a reliable source of truth for
each critical field?
The answer may involve configuration, training, integration,
process redesign, or new software. The right intervention depends on the cause.
Step 5: Define Ownership and Escalation
Every unresolved issue should have a clear owner, a next
action, and an appropriate deadline.
A status label that says “pending” is not a plan.
Pending with whom? Pending for what? Since when? What
happens if nothing changes?
A well-designed process makes those questions answerable
without requiring a staff member to remember the history.
Step 6: Automate the Repetitive Work That Remains
Once the process is understood, automate appropriate
repetitive tasks.
Examples may include routine status checks, reminders,
routing, data validation, and identification of missing information.
Preserve human review for ambiguous cases, clinical
decisions, exceptions requiring judgment, and actions with material
consequences.
Do not allow automation to silently invent missing data,
alter clinical documentation, or represent an unverified requirement as
satisfied.
Step 7: Review Results and Adjust
Compare performance against the baseline.
Did manual touches decline? Did staff spend less time
locating information? Did the targeted error category improve? Did unresolved
exceptions decrease? Did the system create new work elsewhere?
A pilot that fails to improve the intended outcome still
provides useful information—provided the practice examines the result honestly.
The objective is not to prove that the software was a good
purchase.
The objective is to discover what actually works.
The Metrics That Matter More Than an AI Demo
A polished demonstration can make almost any workflow look
simple.
Real practice operations are less cooperative.
Before purchasing an AI or revenue-cycle product, ask how it
will affect measurable outcomes.
Operational reliability
Measure the percentage of tasks completed correctly the
first time, the number of manual touches per claim, and the frequency of
missing or conflicting information.
Resolution speed
Track the time from identifying an exception to assigning
it, acting on it, and resolving it. Distinguish delays caused by the practice
from delays caused by payers or other external requirements.
Financial performance
Monitor denial rates by category, avoidable rework, days in
accounts receivable, collection performance, and write-offs. Interpret each
measure in context; payer mix, specialty, contract terms, and case complexity
matter.
Staff capacity
Measure time spent on repetitive follow-up, information
retrieval, duplicate entry, and manual reconciliation. The purpose is to
determine whether staff gain capacity for higher-value work—not merely whether
a task has moved to another screen.
Auditability and safety
Measure whether the system can show the information used,
actions taken, changes made, and approvals obtained. Review how it handles
uncertainty, incorrect inputs, access controls, and exceptions.
One particularly useful measure is touches per claim.
If the number of touches falls while accuracy and
appropriate oversight remain strong, the practice may be removing unnecessary
work.
If the software reduces clicks but creates more corrections,
escalations, or downstream denials, the improvement may be cosmetic.
The most important question is not how quickly a system can
process a claim.
It is how reliably the practice can move from the patient
encounter to an appropriate financial resolution.
Seven Myths That Deserve Retirement
Myth 1: “We need more automation.”
Sometimes. But if the process is poorly defined, automation
can replicate the same problems at greater speed.
Better question: What recurring failure are we trying to
prevent?
Myth 2: “Our EHR already contains the information.”
Perhaps. But the information may not be structured, current,
connected to the relevant transaction, or available to the person who needs it.
Better question: Can the next person find and use the right
information without reconstructing the case?
Myth 3: “Our experienced biller knows how to handle it.”
That expertise is valuable. It is also vulnerable if it
exists only in one person's memory.
Better question: Can the organization preserve the knowledge
and process so the team can use them consistently?
Myth 4: “AI will eliminate denials.”
No responsible vendor should promise that. Some denials
reflect payer decisions, coverage limits, legitimate documentation
requirements, or disputes that require human judgment.
Better question: Which categories of avoidable errors can we
reduce, and how will we prove it?
Myth 5: “A higher automation percentage means a better
operation.”
Not necessarily. A highly automated process can still
produce errors or require extensive human intervention.
Better question: What work disappeared, what errors
declined, and what new risks emerged?
Myth 6: “The cheapest tool is the most affordable.”
A low subscription price may conceal integration expenses,
training, support, duplicate workflows, or additional manual work.
Better question: What is the total cost of operating the
process before and after implementation?
Myth 7: “The problem is always the payer.”
Payer complexity is real. So are internal process failures.
Treating every problem as the payer's fault prevents a practice from fixing
failures it can control.
Better question: What evidence identifies the cause, and
which part of the problem is within our control?
What to Look for When Evaluating a Revenue-Cycle Tool
An independent practice should not need a technology
department the size of a hospital's to evaluate whether a product is useful.
Start with practical questions.
Does the product fit the existing environment?
Ask which EHRs, practice management systems, clearinghouses,
and data formats it supports. Clarify what requires integration, what remains
manual, and what happens when an interface fails.
Does it preserve context?
Determine whether the system connects information to the
relevant patient, encounter, authorization, claim, payer, and task. Ask how it
handles conflicting or outdated data.
Can it explain its actions?
Ask whether staff can inspect the source information,
decision rules, action history, and approvals associated with an automated
outcome.
Does it handle uncertainty responsibly?
A system should distinguish verified information from
inference. It should escalate ambiguous or consequential situations rather than
manufacture certainty.
Does it reduce work across the process?
Request a pilot with baseline measurements. Count manual
touches, time spent, corrections, and unresolved exceptions—not just the number
of automated tasks.
Can the practice control access and protect information?
Review role-based permissions, authentication, encryption,
logging, retention, vendor access, and incident response. Confirm whether a
business associate agreement is required and in place before protected health
information is handled by a vendor acting as a business associate.
What happens when the product is wrong?
Ask how errors are detected, corrected, reported, and
reviewed. Establish who approves consequential actions and who remains
accountable for operational decisions.
The strongest vendor conversations are not demonstrations of
what AI can say.
They are discussions about what the system can reliably do,
what it cannot do, and how the practice will know the difference.
Efficiency Is Not Permission to Ignore Responsibility
Healthcare automation operates within legal, contractual,
clinical, and ethical constraints.
HIPAA obligations may apply to the practice and to vendors
handling protected health information on its behalf. Depending on the
relationship, a business associate agreement and appropriate safeguards may be
required.
Access should be limited to authorized users and legitimate
purposes. Practices should evaluate how information is transmitted, stored,
retained, and deleted, and how security incidents are handled.
Billing and coding must remain consistent with applicable
documentation, coverage, and coding requirements. AI should not be used to
manufacture documentation, upcode services, create unsupported diagnoses, or
submit claims based on facts that have not been established.
Automation should also respect the distinction between
administrative support and clinical judgment. A tool that assists with workflow
should not quietly assume authority over decisions it is not qualified or
authorized to make.
Finally, accountability must remain clear.
If an AI system identifies an issue, someone should know
whether it is a recommendation, a draft action, or an executed action. Staff
should be able to inspect consequential decisions and correct errors.
The more autonomous a system becomes, the more important it
is to define its boundaries, oversight, and audit trail.
Automate work. Do not automate away responsibility.
Practices should obtain appropriate legal, compliance, and
technical advice for their specific circumstances rather than treating a
software vendor's assurances as a substitute for due diligence.
Where Healthcare AI Is Headed
The next phase of healthcare AI will not be defined solely
by which model produces the most impressive response.
It will increasingly be defined by whether systems can
operate reliably inside real organizations.
That means connecting information across systems,
maintaining state, respecting permissions, handling exceptions, and providing
evidence of what occurred.
In revenue-cycle operations, this could mean identifying a
missing authorization before claim submission, surfacing an unresolved
eligibility issue, routing a task to the right person, monitoring a deadline,
and preserving the history needed to understand the result.
It could also mean recognizing that a problem cannot be
solved automatically and escalating it before a deadline is missed.
The opportunity is substantial, but it should not be
confused with a promise of perfect automation.
Payer requirements will continue to change. Clinical
documentation will remain nuanced. Contracts will differ. Some claims will
require appeals, negotiation, or human review. Systems will occasionally fail.
The goal is to make those realities manageable without
forcing staff to reconstruct the same information repeatedly.
The future may contain fewer disconnected portals, fewer
manual handoffs, and fewer situations in which the only person who understands
a process is the employee who has worked there for twenty years.
That would be progress.
Not because technology has replaced human expertise, but
because it has made that expertise easier to use, preserve, and share.
What This Means for OnnX
At OnnX, we approach medical billing from a different
starting point.
Instead of assuming the answer is simply more downstream
automation, we focus on the relationship between data, workflows, and
revenue.
The premise is that many operational problems become harder
and more expensive when information is incomplete, disconnected, or unavailable
at the moment a decision must be made.
A denial may be the first visible sign of a problem that
began much earlier.
A claim may require repeated correction because a prior step
did not preserve the information the next step needed.
A billing team may spend hours chasing status updates
because ownership, dependencies, and deadlines are not visible in one coherent
operational process.
The opportunity is to address those problems as connected
systems—not as a growing collection of isolated tasks.
For independent practices, the distinction matters.
A large health system may have specialized teams and
substantial IT resources to absorb operational complexity. A small practice has
fewer people, tighter margins, and less capacity to absorb repeated
administrative work.
When a process depends on a particular employee's memory,
the practice carries an invisible operational risk.
When a system preserves the relevant information, tracks the
work, and makes the next appropriate action visible, the organization can
become less dependent on informal workarounds.
That is the direction OnnX is working toward: using
AI-enabled operational intelligence to help independent clinics make their
revenue-cycle processes more consistent, traceable, and manageable.
This is a product philosophy, not a claim that every
capability is already deployed or that all billing problems can be eliminated.
Specific results must be established through implementation, measurement, and
validation.
Our underlying belief is that independent physicians should
not have to choose between caring for patients and building a financially
sustainable practice.
Predictable revenue is not the purpose of medicine.
But without financial stability, independent practices have
less freedom to invest in their teams, serve their communities, and remain
independent.
The work of improving medical billing should therefore begin
before the denial, before the appeal, and often before the claim itself.
It should begin with the information that makes the entire
process possible.
The Question We Should Be Asking
Amritpal Virdee's ICU diary mattered because it preserved
details that could otherwise have disappeared.
It helped him reconnect with a part of his life that he
could not remember.
No one should confuse that deeply personal experience with a
delayed insurance payment. The human consequences are different, and the
comparison has limits.
But the story reminds us of a broader principle: information
has value beyond the moment it is first recorded.
Its value depends on whether it remains available,
understandable, and connected to the decisions that follow.
Healthcare has invested enormous effort in digitizing
records and automating tasks.
The next challenge is to make the information within those
systems work together.
For medical practices, that means fewer mysteries about why
a claim failed, fewer hours spent searching for information already collected,
and clearer accountability for what happens next.
For AI developers, it means moving beyond systems that
merely generate answers toward systems that support reliable, traceable work.
For practice owners, it means evaluating technology by the
burden it removes—not the number of features it adds.
And for the healthcare industry, it means recognizing that a
sophisticated system can still be operationally forgetful.
We do not need every medical practice to become a technology
company.
We need technology to make running a medical practice less
unnecessarily complicated.
The next breakthrough in medical billing may not be another
tool that processes claims faster. It may be a system that makes fewer claims
require rescue in the first place.
That is a more interesting goal than simply adding AI to the
billing department.
And it is a much better reason to build technology.
One final question for physicians and practice owners: If
your billing team disappeared for two weeks, would your systems preserve the
work—or would your practice discover that its most important operating manual
was stored in someone's head?
I would love to hear how physicians, practice
administrators, and revenue-cycle professionals are tackling this problem.
What consumes more time in your practice today: doing the
work, or figuring out what happened to work someone already did?
Share your experience in the comments. If this perspective
would help another physician or practice owner, consider reposting the article.
About the Author
Dr. Daniel Cham is a physician, medical consultant,
and healthcare technology entrepreneur. He is the founder of OnnX, which
focuses on AI-enabled approaches to medical billing and revenue-cycle
operations for independent medical practices.
His work explores how better information architecture,
operational workflows, and responsible automation can help physicians spend
less time navigating administrative complexity and more time building
sustainable practices.
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Knowledge creates opportunity for progress.
References and Further Reading
- Sandwell
and West Birmingham NHS Trust. “ICU diary helps heart attack
patient piece together missing memories.” October 23, 2026. The original
story of Amritpal Virdee, his family, and the ICU diary.
- MobiHealthNews.
“Healthcare AI’s value depends on adoption, outcomes and costs.” October
23, 2026. Reporting on the HIMSS AI in Healthcare Forum, including Nassib
Chamoun’s comments about measuring operational and economic impact.
- American
Medical Association. “AMA survey: Prior authorization reform
pledge falls short with physicians.” May 2026. Survey findings on
physician workload, delayed care, and prior authorization.
Disclaimer
This article is intended for general educational and
informational purposes. It does not constitute medical, legal, coding,
reimbursement, compliance, or financial advice. Healthcare billing requirements
vary by payer, contract, specialty, jurisdiction, and service. Practices should
consult qualified professionals regarding their specific circumstances. The
discussion of OnnX describes its guiding approach and intended value; it is not
a guarantee of financial, clinical, or operational results.
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#HealthcareAI #ArtificialIntelligence #HealthTech #IndependentMedicalPractices
#PhysicianEntrepreneurs #HealthcareInnovation #DataQuality #WorkflowAutomation
#MedicalPracticeManagement #ClaimsManagement #PriorAuthorization #OnnX
