Healthcare doesn't happen in departments. It happens in the spaces between them—and that is where patients, physicians, and practices often lose time, trust, and money.
“Care does not have to be finished in one encounter. But
it must not be allowed to disappear between encounters.” — Alan
P. Feren, MD
That sentence stopped me.
Not because it is complicated.
Because it is obvious.
And yet much of modern healthcare is designed as though the
opposite were true.
The appointment ends.
The physician moves to the next patient.
The patient leaves.
The chart closes.
The referral goes somewhere.
The claim enters another system.
The authorization enters another queue.
The bill arrives weeks later.
And somewhere along the way, everybody assumes somebody else
is taking care of the rest.
That is where the trouble begins.
A 14-year-old girl in Michigan offers an unexpectedly
powerful way to understand the problem.
Her name is Ava Little.
Ava was diagnosed with Charcot-Marie-Tooth disease, or
CMT, at three years old. Fourteen years later, the condition remains part
of her life. She has dealt with physical challenges, unwanted attention because
of the way she walks, and the ordinary complications of growing up while living
with a genetic disorder.
But she made a choice.
She decided she did not want to sit on the sidelines.
As WDIV Local 4 reported this week, Ava has turned her
experience into advocacy, fundraising, and awareness work for CMT. She is
captain of the “Little But Mighty” team participating in the annual Walk
for CMT in Lansing. Her involvement also earned her a Go-4-It Award.
Her father, Matthew Little, knows CMT personally.
So does Ava's brother, Ethan Little.
An earlier Charcot-Marie-Tooth Association family profile
identified Ava with her parents, Lisa Little and Matt Little, and her
brother Ethan.
Matthew explained to WDIV that everyone in the family has
CMT1A, but the condition affects them differently. He and his son have
relatively mild symptoms, while Ava experiences the disease more intensely.
Same family.
Same broad diagnosis.
Different experience.
That distinction is the real story.
Because healthcare has a similar problem.
We keep designing healthcare around the diagnosis, the
encounter, the claim, or the department.
But the patient experiences none of those things separately.
The patient experiences one life.
And one healthcare journey.
Ava Little's Story Is Not Really About CMT
It is tempting to read Ava's story as a story about rare
disease.
It is.
But it is also about something much bigger:
agency.
Ava didn't choose CMT.
She didn't choose the symptoms.
She didn't choose the questions from strangers.
She didn't choose the limitations imposed by her condition.
But she could choose how she responded.
And she chose action.
She chose advocacy.
She chose fundraising.
She chose community.
She chose not to disappear behind the diagnosis.
That matters to physicians.
Because patients don't want to be passive recipients of
healthcare.
They want to understand what is happening.
They want to know what happens next.
They want to know who is responsible.
They want their concerns remembered.
They want the system to recognize that they are a person
rather than an encounter number.
And increasingly, they want something else:
They want visibility.
Not necessarily visibility into every technical detail.
Visibility into their own journey.
What happened?
Why?
What comes next?
What do I need to do?
Who do I contact?
What will this cost?
Why did insurance deny it?
Why am I receiving this bill?
Why does the bill say one thing while the insurance
statement says another?
Those questions aren't peripheral to healthcare.
For the patient, they are healthcare.
The Healthcare Industry Has a Strange Definition of
“Patient-Centered”
Here's my slightly provocative question:
If the patient has to navigate the system alone, how
patient-centered is the system?
We love the phrase.
Patient-centered care.
Patient engagement.
Patient empowerment.
Patient experience.
Digital health.
Consumer healthcare.
Beautiful words.
But then the patient gets a bill they can't understand.
Or a referral disappears.
Or a prior authorization stalls.
Or they have to call the insurance company because the
physician's office can't determine why something was denied.
Then the language suddenly changes.
“That is the payer's issue.”
“That is billing.”
“That is scheduling.”
“That is utilization management.”
“That is the clearinghouse.”
“That is the patient's responsibility.”
Technically, those statements may be correct.
Humanly, they are almost meaningless.
The patient doesn't have a payer problem.
The patient has a healthcare problem.
And they expect the people providing healthcare to help
navigate it.
The Patient Doesn't Know Your Organizational Chart
This is one of the most important principles for practice
owners:
The patient does not experience your organizational
chart.
They don't know:
- who
handles eligibility
- who
handles coding
- who
submits claims
- who
works denials
- who
posts payments
- who
handles appeals
- who
manages prior authorization
- who
handles credentialing
- who
owns the patient portal
- who
manages your clearinghouse
And frankly?
They shouldn't have to.
A patient has enough on their plate.
They're sick.
Or worried about becoming sick.
They're taking care of children.
They're taking care of parents.
They're working.
They're missing work.
They're paying for medications.
They're arranging transportation.
They're trying to understand what a physician just told
them.
They don't need another part-time job:
Insurance Claims Analyst.
Yet that's effectively what healthcare sometimes asks them
to become.
Here's the Contrarian Part
Medical billing is not a back-office function.
There.
I said it.
And I know some revenue-cycle professionals will disagree.
That's okay.
Let's define what I mean.
I'm not saying billing is clinical care.
It isn't.
I'm saying the consequences of billing are part of the
patient experience.
If a patient receives an incorrect bill, that affects trust.
If a claim is repeatedly denied, that affects access.
If an authorization delays treatment, that affects care.
If a financial estimate is unclear, that affects
decision-making.
If staff spend hours chasing a claim, that affects practice
capacity.
If physicians spend hours dealing with administrative
problems, that affects the amount of time available for clinical work.
The department may be called “revenue cycle.”
The patient experiences it as:
“What happened to my healthcare?”
That's a very different perspective.
The 15-Minute Appointment Is Not the Boundary of Care
This is where Alan P. Feren, MD's recent essay becomes
particularly relevant.
Writing this week, Feren argues that care doesn't have to be
completed in one encounter, but it cannot simply disappear between encounters.
He distinguishes the medical service from the larger process of actual care:
explanation, treatment planning, follow-through, reassessment, and
responsibility for what happens next.
That idea should change how practice owners think about
operations.
Because healthcare doesn't end when the physician clicks:
Sign Encounter.
The patient still has to:
- obtain
the medication
- schedule
the referral
- complete
the test
- receive
the result
- understand
the result
- follow
the treatment plan
- navigate
insurance
- return
for reassessment
- pay
the appropriate balance
The clinical encounter is an event.
Healthcare is an episode.
And the episode is where many systems fail.
The Claim Is Also an Episode
Think about a claim.
It doesn't simply exist.
It travels.
Patient information enters the system.
Eligibility is checked.
The encounter occurs.
Documentation is completed.
Codes are assigned.
The claim is created.
The claim is scrubbed.
The claim is submitted.
The payer adjudicates it.
Payment arrives.
The payment is posted.
A denial may appear.
Someone investigates.
Someone corrects something.
Someone appeals.
Someone follows up.
Then perhaps the patient receives a balance.
That's not one event.
It's an ecosystem.
And every handoff is an opportunity for information to
disappear.
Which brings us to an uncomfortable question:
Why do we design healthcare around handoffs and then act
surprised when things fall between them?
The Handoff Tax
Every time information moves from one person, system,
department, or organization to another, there is a potential cost.
Call it the handoff tax.
It isn't always financial.
Sometimes it is:
- duplicated
work
- delayed
work
- missing
information
- contradictory
information
- manual
reconciliation
- patient
confusion
- staff
frustration
- physician
interruption
- delayed
payment
The more handoffs, the more opportunities for something to
become unclear.
And healthcare has become spectacularly good at creating
handoffs.
Physician to staff.
Staff to payer.
Payer to provider.
Provider to clearinghouse.
Clearinghouse to payer.
Payer to patient.
Patient back to practice.
Practice back to payer.
At some point you almost expect a marching band to appear.
The Administrative Tax on Medicine
The scale of administrative work isn't theoretical.
The American Medical Association's 2025 Prior Authorization
Physician Survey found that physicians complete an average of 40 prior
authorization requests per week, while physicians and staff spend an
average of 13 hours per week completing them. The AMA reported that 95%
of physicians say prior authorization delays necessary care, 94% say it
contributes to burnout, and 26% report that it has contributed to a serious
adverse event.
Read that again.
Thirteen hours.
That's not a little paperwork.
That's a significant portion of a working week.
And that's just prior authorization.
Add:
Claims.
Denials.
Eligibility.
Credentialing.
Documentation.
Coding.
Appeals.
Patient balances.
Payer portals.
Referral management.
And the occasional fax machine that apparently refuses to
die.
The industry keeps calling this administration.
At some point, we should probably call it what it is:
operational infrastructure.
The Fax Machine Has Become a Healthcare Immortal
There are many mysteries in healthcare.
Why does a simple referral sometimes require three phone
calls?
Why does a payer portal need another password?
Why does one payer accept electronic documentation while
another asks for a fax?
Why can a claim be visible in one system but not another?
Why does someone occasionally say:
“We never received it.”
And why, after all the technological revolution of the last
two decades, is a fax machine still somehow involved?
We have artificial intelligence.
We have cloud computing.
We have smartphones more powerful than the computers that
sent people to the moon.
And somewhere in a medical office:
“Can you fax that again?”
Maybe the problem isn't that healthcare lacks technology.
Maybe healthcare lacks integration and operational
discipline.
Stop Adding People to Broken Workflows
Here's another idea that may make some practice owners
uncomfortable:
More staff is not always the answer.
Sometimes you genuinely need more people.
But before hiring another person, ask:
Why does this work exist?
Then ask:
Why does a human have to do it?
Then:
Why does that human have to do it repeatedly?
Then:
Why are we discovering the problem this late?
Then:
Could the problem have been prevented upstream?
Those questions are more valuable than simply asking:
“Who can we hire?”
Because a broken process with more people becomes a larger
broken process.
It doesn't magically become efficient.
Your Best Employee May Be Spending Half the Day Fixing
Yesterday
This is one of the hidden costs of healthcare
administration.
Your smartest employee may not be creating value.
They may be repairing value that was already created
incorrectly.
A claim was entered incorrectly.
Now someone fixes it.
Eligibility wasn't verified.
Now someone calls.
A modifier was missing.
Now someone researches it.
A payer denied something.
Now someone appeals it.
A patient doesn't understand the statement.
Now someone explains it.
A payment doesn't match expectations.
Now someone reconciles it.
The employee is working.
Hard.
Productively.
And yet the organization may still be losing.
Because the work is reactive.
The goal shouldn't simply be to make people better at
cleaning up mistakes.
The goal is to create fewer mistakes to clean up.
The Denial Is Not the Victory
Here's a revenue-cycle paradox I think deserves more
attention:
We celebrate denial recovery.
Of course we should recover legitimate revenue.
But imagine a hospital announcing:
“We repaired 8,000 plumbing leaks this year.”
Wonderful.
But the next question would be:
Why were there 8,000 leaks?
Healthcare sometimes does the same thing with denials.
We celebrate the amount recovered.
But we don't always ask:
How many of those denials should never have happened?
Recovery matters.
Prevention matters more.
The real operational question isn't:
“How good are we at fighting denials?”
It's:
“Why are the same denials happening again?”
Your Denial Report Is a Map
A denial report isn't merely an accounting document.
It is a map of system failure.
If eligibility problems keep appearing, something upstream
may need attention.
If documentation-related denials recur, the clinical
workflow may need improvement.
If one payer repeatedly produces a certain denial category,
that pattern deserves investigation.
If claims from a specific provider or service line behave
differently, there may be a process issue worth understanding.
If the same denial reason appears month after month, you
don't have a denial problem.
You have an information problem.
The denial is simply where the problem became visible.
The Three Questions Every Practice Should Ask
Forget the 50-page dashboard for a moment.
Start with three questions.
1. Where are we losing money?
Not just total A/R.
Where?
Which payer?
Which service?
Which denial?
Which stage?
2. Where are we losing time?
Which tasks consume staff hours?
Which claims require repeated touches?
Which workflows cause the most interruptions?
3. Where are we losing trust?
What causes patients to call?
What causes confusion?
What generates complaints?
What financial questions are staff repeatedly answering?
The interesting part is that these three questions may have
the same answer.
The Patient Bill Is a Product
Here's an idea I wish more practices considered:
Your patient statement is a product.
And like every product, it has a user.
The user is a human being who may not understand medical
billing.
So ask:
Can they understand it?
Can they tell what service it relates to?
Can they understand what insurance paid?
Can they understand what remains?
Can they determine what to do next?
Can they find help?
Can they challenge an error?
Or does the statement essentially say:
“Here is a number. Good luck.”
We wouldn't design a consumer app that way.
Why do we tolerate it in healthcare?
Patients Don't Need More Transparency
They Need More Comprehensibility.
This distinction matters.
Healthcare loves transparency.
Show the patient more data.
Give them more documents.
Give them another portal.
Send another explanation of benefits.
Put another notification in the app.
Congratulations.
The patient now has 14 pieces of information and no idea
what they mean.
Transparency without comprehension is just information
overload.
The goal should be understandable information.
What happened?
Why?
What does it mean?
What should I do?
Who can help?
That is patient-centered administration.
And Then There's AI
Every healthcare conference currently seems to contain
approximately seventeen presentations titled:
“The Future of AI in Healthcare.”
Most begin with a futuristic image.
Usually a glowing brain.
Sometimes a robot.
Occasionally both.
Then comes the inevitable statement:
“AI will transform healthcare.”
Maybe.
But here's the boring truth:
AI cannot compensate for a badly designed process simply
because it has a better vocabulary.
If your workflow is broken, AI can automate the broken
workflow.
Faster.
That's not necessarily progress.
Don't Automate Chaos
This should become a rule:
Do not automate a process you haven't understood.
Before deploying AI, map the workflow.
Where does the data originate?
Where does it change?
Where does it get duplicated?
Where does it disappear?
Where does a human intervene?
Why?
Where does the decision occur?
Who owns the exception?
What happens when the system is wrong?
Only then ask:
Where could AI help?
That's a much more sophisticated technology strategy.
Where AI Actually Makes Sense
AI is particularly interesting when it can help with work
that is:
- repetitive
- rules-driven
- data-intensive
- time-consuming
- pattern-dependent
- difficult
to prioritize manually
That can include areas such as:
- claim
review
- denial
categorization
- workflow
prioritization
- payer-pattern
detection
- eligibility
workflows
- documentation
checks
- anomaly
detection
- administrative
communication
- work-queue
optimization
But the goal should not be:
“Replace the humans.”
The goal should be:
“Stop wasting human judgment on mechanical work.”
That's a much better bargain.
The Human Still Matters
There is a dangerous misconception about automation.
That every human task is inefficient.
It isn't.
Some tasks require judgment.
Some require context.
Some require empathy.
Some require negotiation.
Some require clinical understanding.
Some require knowing when the rules don't fit the patient.
Technology should handle predictable work.
Humans should handle exceptions, judgment, communication,
and accountability.
The future isn't:
Humans versus machines.
It's:
Humans doing the work that actually deserves humans.
This Is Why the Middleman Question Matters
For independent and small-to-midsize practices, another
question deserves attention:
How much control should the practice surrender in
exchange for convenience?
Outsourcing isn't inherently bad.
Neither is bringing work in-house.
The issue is visibility.
If a practice outsources billing but cannot answer:
- why
claims are denied
- where
A/R is accumulating
- what
staff are doing
- what
payers are causing problems
- which
workflows are failing
- how
much rework exists
then it may have outsourced more than labor.
It may have outsourced understanding.
That's dangerous.
A physician practice should not need to become a billing
company.
But it should understand its own revenue cycle.
This Is the Philosophy Behind OnnX
This is where OnnX enters the conversation.
I founded OnnX around a simple idea:
Small and midsized medical practices should not have to
surrender operational visibility just because medical billing is complicated.
OnnX is an AI-powered medical billing SaaS designed to help
practices reduce unnecessary administrative friction and move toward greater
visibility and control without relying entirely on traditional middleman-heavy
workflows.
The objective isn't to add another dashboard to a
physician's life.
Nobody wakes up thinking:
“I hope someone gives me another dashboard today.”
The objective is to make the underlying workflow more
intelligent.
More visible.
More actionable.
More connected.
The important distinction is this:
Automation should not hide the work.
It should make the work easier to understand.
The Difference Between Outsourcing Work and Outsourcing
Understanding
This distinction is central to the future of medical
billing.
A practice can outsource repetitive labor.
That's reasonable.
But outsourcing understanding is different.
If the practice doesn't know:
What is happening?
Why is it happening?
Who owns it?
What should happen next?
then the practice isn't really in control.
Technology should reverse that.
The physician doesn't need to personally work every claim.
But the physician or practice owner should be able to
understand the system.
That is operational intelligence.
The 30-Day Practice Challenge
If you're a physician owner, try something simple.
Don't transform everything.
Pick one month.
Days 1–5: Measure
Document:
- clean-claim
rate
- denial
rate
- denial
reasons
- days
in A/R
- A/R
over 90 days
- patient
balance aging
- staff
hours spent on billing
- manual
claim touches
- average
time to resolution
Don't fix anything yet.
Measure.
Days 6–10: Trace
Pick one denied claim.
Follow it from beginning to end.
Where did the information originate?
Who touched it?
What changed?
Where did the problem appear?
Could it have been detected earlier?
Do this repeatedly.
Patterns will emerge.
Days 11–15: Categorize
Divide problems into:
Preventable.
Partially preventable.
Unavoidable.
Don't waste your team's energy pretending every payer
behavior can be controlled.
Focus on what you can influence.
Days 16–20: Prioritize
Pick three recurring problems.
Not ten.
Three.
Rank them by:
- financial
impact
- staff
time
- patient
impact
- frequency
- ease
of intervention
Then tackle them.
Days 21–25: Automate
Identify repetitive work.
Ask:
Could software do this?
If yes:
Could it do it safely?
If yes:
How would a human verify exceptions?
That third question is the one people skip.
Don't skip it.
Days 26–30: Review
Compare the baseline.
What improved?
What didn't?
What surprised you?
What should be redesigned next?
The objective isn't perfection.
It's learning.
The Metrics That Actually Matter
A practice doesn't need 200 KPIs.
Start with a manageable group.
Clean-Claim Rate
How often do claims pass through correctly the first time?
Denial Rate
How frequently are claims denied?
Denial Recurrence
How often are the same problems happening again?
Days in A/R
How quickly is outstanding revenue being resolved?
A/R Over 90 Days
How much money is becoming increasingly difficult to
collect?
Cost to Collect
How much operational effort does revenue generation require?
Manual Touches
How many times does a claim require human intervention?
Staff Hours per 100 Claims
This connects revenue performance to labor.
Patient Billing Contacts
How often are patients calling because they don't understand
a bill?
Physician Administrative Hours
How much physician time is being consumed by nonclinical
administrative work?
That last metric deserves much more attention.
The Metric Nobody Likes
Here's the number that may make practice owners
uncomfortable:
How many physician hours are being consumed by work that
does not require a physician?
Think about that.
A physician costs more than an administrative employee.
A physician's time is scarce.
A physician's time is clinically valuable.
And yet physicians routinely get pulled into:
- authorization
issues
- documentation
questions
- payer
disputes
- patient
billing questions
- administrative
escalations
- referral
problems
Sometimes the physician must be involved.
Often they don't.
If you can return even a small amount of physician time to
clinical work, the operational impact can be meaningful.
Legal and Compliance Reality
Technology does not eliminate compliance obligations.
It creates new ones.
Any practice using automation or AI in revenue-cycle
operations should understand issues around:
- HIPAA
and privacy
- data
security
- access
controls
- audit
trails
- appropriate
use of patient information
- payer
requirements
- coding
standards
- documentation
- fraud
and abuse laws
- contractual
obligations
- state
requirements
- business
associate relationships
- AI
governance
And one question deserves special attention:
What happens when the AI is wrong?
Every responsible system needs an answer.
Who reviews it?
Who can override it?
Is the decision documented?
Can the organization reconstruct what happened?
Can an error be corrected?
Can access be revoked?
What data is being used?
Where is it stored?
Is patient information being used for model development?
Who has access?
What happens during downtime?
Those aren't futuristic questions.
They're governance questions.
Ethics: Efficiency Isn't the Only Goal
There is another trap.
Healthcare can become so obsessed with efficiency that it
forgets what efficiency is supposed to serve.
The objective is not simply:
more collections.
The objective is accurate, appropriate, transparent
financial operations that support sustainable care.
A patient shouldn't be treated like an outstanding balance.
A denial shouldn't automatically become an aggressive
collection opportunity.
An algorithm shouldn't become an unreviewable authority.
Automation shouldn't eliminate accountability.
And convenience for the practice shouldn't automatically
become inconvenience for the patient.
The patient is not the friction to be optimized away.
The friction is.
That distinction is fundamental.
What About Independent Practices?
Independent practices face a particularly difficult
balancing act.
They need:
- clinical
autonomy
- financial
sustainability
- operational
efficiency
- technology
- compliance
- staffing
- patient
trust
But they often don't have the administrative infrastructure
of large health systems.
That creates an interesting technology opportunity.
The answer isn't necessarily to become bigger.
It may be to become smarter.
A 10-provider practice doesn't need to replicate the
bureaucracy of a 10,000-provider health system.
It needs systems that give a smaller organization leverage.
That's where intelligent automation can become particularly
valuable.
The Future Is Not “No Humans”
I don't believe the future of medical billing is a
completely human-free system.
That would be a mistake.
The future is more likely to be:
less repetitive human work + more human oversight +
better information.
The machine handles the predictable.
The human handles the exception.
The practice owns the visibility.
The patient receives clearer communication.
The physician gets more time back.
That is a future worth building.
What Healthcare Gets Wrong About Innovation
Healthcare often defines innovation as:
new technology.
But innovation can be much simpler.
Eliminating a redundant step is innovation.
Removing a fax is innovation.
Making a bill understandable is innovation.
Preventing a denial is innovation.
Giving staff better information before they make a phone
call is innovation.
Giving a physician five hours back each month is innovation.
Making a patient understand what happens next is innovation.
Technology is merely one mechanism.
The real innovation is reducing unnecessary friction.
The Patient Experience Is an Operational Outcome
This may be the most important idea in the article.
Patient experience isn't just:
“Did the doctor have a good bedside manner?”
It's also:
Did the referral happen?
Did the authorization happen?
Did the result arrive?
Did someone follow up?
Did the patient understand the plan?
Did the bill make sense?
Did the practice respond?
Did the patient know what happens next?
That means patient experience isn't exclusively a
communications function.
It is an operational outcome.
And operational outcomes can be measured.
The Ava Little Test
Here's a simple test I would give every healthcare workflow.
Imagine Ava Little is using your system.
Not a billing expert.
Not a healthcare administrator.
Not a coder.
A teenager living with a chronic condition.
Could she understand:
What happened?
Why?
What happens next?
Who is responsible?
What does she need to do?
If the answer is no, perhaps the workflow is designed for
the organization rather than the patient.
And that is the distinction we need to confront.
Healthcare Has an Interesting Habit
We often build systems around what is convenient for the
organization.
Then we ask patients to adapt.
Patients should use the portal.
Patients should call the insurer.
Patients should understand the statement.
Patients should remember the referral.
Patients should know when to follow up.
Patients should figure out the authorization.
Patients should bring the paperwork.
Patients should wait.
At some point, we need to reverse the question.
Instead of asking:
“Why can't patients follow our process?”
Ask:
“Why did we build a process patients can't reasonably
follow?”
That question is much more interesting.
And much more productive.
The Humor Hides a Serious Problem
Healthcare has spent years teaching people to laugh at
administrative absurdity.
We joke about prior authorization.
We joke about fax machines.
We joke about insurance hold music.
We joke about portals.
We joke about paperwork.
But humor can sometimes hide normalization.
When everyone jokes about the same broken process for 15
years, perhaps the problem isn't that the joke is funny.
Perhaps the problem is that we stopped expecting the
system to change.
That's dangerous.
What Physicians Should Stop Saying
Maybe we should retire a few phrases.
“That's just how insurance works.”
Maybe.
But which part?
And is it actually unavoidable?
“Billing will handle it.”
Who specifically?
And when?
“We'll figure it out later.”
Later has an unfortunate tendency to become never.
“The patient knows what to do.”
Do they?
“We need another person.”
Maybe.
But what problem will that person solve?
“AI will take care of it.”
Which part?
Under what rules?
With what oversight?
“It's only administrative.”
If it consumes physician time, staff time, patient time, or
access to care, it isn't insignificant.
The Question Every Practice Owner Should Ask
If I walked into your practice tomorrow and asked:
Where is money getting stuck?
Could you answer?
Then:
Where is staff time getting stuck?
Could you answer?
Then:
Where is patient trust getting stuck?
That's the interesting question.
Because these may all be connected.
A claim problem consumes staff time.
Staff time creates backlog.
Backlog creates delay.
Delay creates patient frustration.
Patient frustration creates calls.
Calls consume more staff time.
More work creates more backlog.
And suddenly everyone is “busy.”
But busy isn't the same as effective.
A system can be incredibly busy and still be broken.
The Real Goal
The goal isn't a perfect revenue cycle.
There is no such thing.
Payers change rules.
Patients change insurance.
Technology fails.
People make mistakes.
Healthcare is complicated.
The goal is something more realistic:
Make the system visible enough to improve.
When something goes wrong, know why.
When something repeats, notice it.
When something can be prevented, prevent it.
When something can be automated safely, automate it.
When something requires judgment, keep a human involved.
When something affects patients, measure the patient impact.
That is operational maturity.
And That Brings Us Back to Ava
Ava Little was diagnosed at three years old.
Today she is 14.
Her diagnosis remains part of her life.
But it doesn't define all of it.
She has chosen to advocate.
To raise awareness.
To fundraise.
To connect with other people living with CMT.
To lead.
Her father, Matthew Little, told WDIV that her attitude
toward raising money makes him proud. Ava also described how participating in
the CMT walk helped her regain confidence and connect with people who
understand what she is going through.
And then she said something that should stay with anyone
working in healthcare:
“I just didn’t want to sit on the sidelines anymore.”
That is more than a quote.
It's a challenge.
Because patients shouldn't sit on the sidelines of their own
healthcare.
Physicians shouldn't sit on the sidelines of their own
practices.
Practice owners shouldn't sit on the sidelines of their own
revenue cycle.
And staff shouldn't spend their careers sitting inside
administrative queues waiting for someone else to fix a problem.
The Future of Medical Billing Is Bigger Than Billing
I believe the next generation of medical billing will be
less about processing transactions and more about understanding the system
around those transactions.
That means:
Better visibility.
Better prevention.
Better automation.
Better data.
Better accountability.
Better communication.
Fewer handoffs.
Fewer surprises.
And fewer situations where the answer to a patient's
question is:
“You'll need to call your insurance company.”
Technology cannot eliminate every problem.
But it can help us stop pretending that unnecessary problems
are inevitable.
Three Expert Perspectives Worth Keeping in Mind
1. Alan P. Feren, MD: Care Continues Beyond the Encounter
Feren's September 24 essay argues that care shouldn't
disappear simply because the scheduled encounter has ended. He emphasizes
explanation, responsibility, follow-through, and support beyond the initial
visit.
The operational lesson: Your workflow after the
appointment is part of the care experience.
2. The American Medical Association: Administrative
Friction Is Measurable
The AMA's 2026 reporting on its prior-authorization survey
documents substantial physician and staff time devoted to authorization work,
alongside reported delays in care and burnout.
The operational lesson: Administrative burden isn't
just a complaint. It can be measured in hours, delays, and resource allocation.
3. Ava Little: Patients Want Agency
Ava's story demonstrates the human side of the equation.
Her diagnosis did not disappear.
The challenges did not disappear.
But she found a way to participate, advocate, and help
others.
The operational lesson: Patient-centered healthcare
should give people understandable information and meaningful participation
rather than forcing them to navigate complexity alone.
Recent Healthcare Signals Worth Watching
The timing of this conversation is important.
The AMA's September 25, 2026 advocacy update is emphasizing
implementation of electronic prior-authorization infrastructure and the need
for health plans, EHR vendors, and health systems to prepare for upcoming
requirements. The AMA notes that physicians and staff currently spend an
average of 13 hours each week on prior authorization.
That means the industry is moving toward more electronic
infrastructure.
But here's the contrarian question:
Will digitizing a bad process actually make it a good
process?
Not automatically.
A digital fax is still a fax.
A digital bottleneck is still a bottleneck.
An automated denial is still a denial.
Technology creates leverage.
It does not automatically create wisdom.
Five Pitfalls to Avoid
Pitfall 1: Buying technology before mapping the workflow
You may automate the wrong thing.
Pitfall 2: Measuring collections without measuring effort
More revenue isn't the entire story.
How much did it cost in staff time to obtain it?
Pitfall 3: Treating every denial equally
Some denials are worth immediate attention.
Others may be low-value or unavoidable.
Prioritization matters.
Pitfall 4: Assuming the vendor owns the outcome
A vendor can provide technology or services.
The practice still needs governance.
Pitfall 5: Forgetting the patient
A revenue-cycle strategy that improves collections while
destroying patient trust is not necessarily an operational success.
Five Questions to Ask Any AI Billing Vendor
Before buying anything, ask:
1. What exactly is automated?
Not “AI-powered.”
What specifically?
2. What happens when the system is uncertain?
Is there human review?
3. Can I audit what happened?
Can the practice reconstruct decisions and actions?
4. What happens to my data?
Where is it stored?
Who can access it?
How is it protected?
How is it used?
5. Can I actually see what's happening?
If the answer is another 50-page report, keep asking
questions.
The Most Important Question
There is one question I would put above all five:
Does this technology give my practice more control—or
simply give me another vendor to call?
That question gets to the heart of the matter.
Technology should reduce dependency where appropriate.
It should increase visibility.
It should make work easier to understand.
It should create leverage.
It should not create another black box.
A Different Definition of Efficiency
Maybe healthcare needs to redefine efficiency.
Efficiency isn't:
“How fast can we process this claim?”
It is:
“How much unnecessary work did we eliminate?”
Efficiency isn't:
“How many denials did we recover?”
It is:
“How many preventable denials did we stop?”
Efficiency isn't:
“How many patient calls did staff answer?”
It is:
“How many calls did we make unnecessary?”
Efficiency isn't:
“How many hours did the physician work?”
It is:
“How much physician time was spent where physician
expertise actually mattered?”
That is a very different way to think about operations.
What If the Best Billing System Is Almost Boring?
This may sound strange coming from someone building an
AI-powered billing platform.
But here it is:
The best technology should eventually feel boring.
You shouldn't need to think about it constantly.
It should simply:
catch problems,
surface exceptions,
organize work,
show patterns,
and help people act.
No fireworks.
No robot speeches.
No “revolutionary transformation” every Tuesday.
Just fewer problems.
That's real innovation.
Final Thoughts
Ava Little didn't choose her diagnosis.
But she chose not to sit on the sidelines.
Healthcare cannot eliminate every hardship patients face.
But it can eliminate unnecessary friction.
Physicians cannot control every payer decision.
But they can control whether their practices understand the
patterns surrounding those decisions.
Technology cannot solve every administrative problem.
But it can help humans spend less time fixing predictable
problems and more time exercising judgment where it matters.
The future of healthcare will not be defined only by what
happens in the exam room.
It will also be defined by what happens before the patient
arrives, after the patient leaves, and everywhere the patient's information
travels in between.
That is where trust is built.
That is where time is lost.
That is where money gets stuck.
And that is where healthcare has an enormous opportunity to
do better.
Your Turn
Here's the question I want to put to physicians and practice
owners:
What is the administrative problem in your practice that
everyone has learned to tolerate—but nobody should have to?
Is it denials?
Prior authorization?
Eligibility?
Patient statements?
Referral management?
Credentialing?
An EHR workflow that requires six clicks for something that
should require two?
Or something else entirely?
Tell me in the comments.
I genuinely want to know what physicians are seeing on the
ground.
And if this article challenged how you think about medical
billing, repost it for another physician, practice owner, administrator,
or healthcare technology leader.
Maybe the next great healthcare improvement isn't another
clinical breakthrough.
Maybe it's removing one unnecessary obstacle that thousands
of physicians and millions of patients have simply learned to live with.
Free Resource
I've placed a free practical resource in the Featured
section of my LinkedIn profile for physicians and practice owners who want
to examine their revenue-cycle workflows more systematically.
No signup required.
Use it with your team.
Challenge it.
Adapt it.
And most importantly, measure what changes.
Continue the Conversation
I write and speak about the intersection of medicine,
technology, healthcare operations, medical billing, and physician
entrepreneurship.
Follow the conversation through my website, podcast, YouTube
channel, X, Facebook, and LinkedIn.
Connect with Dr.
Daniel Cham on LinkedIn
The goal isn't simply to talk about what's wrong with
healthcare.
It's to ask better questions about what we can build next.
Knowledge drives progress. Better questions drive better
systems.
About the Author
Dr. Daniel Cham is a physician and medical consultant
specializing in medical technology consulting, healthcare management, and
medical billing.
He is the founder of OnnX, an AI-powered medical
billing SaaS focused on helping small and midsized medical practices reduce
administrative friction while maintaining greater visibility and control over
their revenue-cycle operations.
His work explores the intersection of clinical medicine,
healthcare technology, practice management, revenue-cycle strategy, and
physician entrepreneurship.
Disclaimer
This article is intended for general educational and
informational purposes only. It does not constitute medical, legal, financial,
coding, compliance, reimbursement, or other professional advice. Healthcare
organizations should obtain advice from appropriately qualified professionals
regarding their specific clinical, operational, contractual, regulatory,
billing, privacy, security, and compliance circumstances.
References
1. Alan P. Feren, MD — “The 15-minute appointment is not
the boundary of care,” KevinMD, September 24, 2026. Feren argues that the
clinical encounter is only one part of care and that responsibility,
explanation, and follow-through must continue beyond the scheduled appointment.
Read
the full article
2. WDIV Local 4 — “Go 4 It: 14-year-old Michigan girl
turns rare disease diagnosis into mission to help others,” September 24, 2026.
The report profiles Ava Little, her CMT1A diagnosis, her advocacy and
fundraising efforts, and comments from her father, Matthew Little. Read
the WDIV story
3. American Medical Association — “Sept. 25, 2026:
National Advocacy Update.” The AMA's latest update discusses electronic
prior-authorization implementation and cites its survey finding that physicians
and staff spend an average of 13 hours per week on prior authorization. Read
the AMA update
One Last Question
What if the biggest opportunity in healthcare isn't
making the patient visit faster?
What if it is making everything around the visit work
better?
Because care doesn't end when the physician leaves the room.
The claim doesn't end when it is submitted.
The patient relationship doesn't end when the encounter is
signed.
And the practice doesn't stop operating when the physician
closes the exam-room door.
Healthcare is a continuous experience.
We should build it that way.
Ava Little didn't want to sit on the sidelines.
Maybe it's time we stopped asking patients, physicians, and
practice staff to do exactly that.
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#MedicalTechnology #HealthcareOperations #OnnX
