If healthcare can find a new path when a mother’s kidney doesn’t match her daughter, why do we keep accepting broken paths in medical billing?
“AI should be a tool that empowers physicians, restores
time with patients, and ultimately humanizes healthcare.” — Dr.
Imamu “Mu” Tomlinson, emergency physician and CEO of Vituity
There is a healthcare story this week that has nothing to do
with an AI unicorn, a billion-dollar acquisition, a new drug launch or another
promise that technology will somehow save us from ourselves.
It is about a young woman named Alexandria Warner.
And her mother, Sue Levy Giles.
And a kidney.
And, surprisingly, it may tell us something important about
medical billing.
Alexandria was a young college student when a devastating
car crash changed the trajectory of her life.
The crash severely injured her. Among the consequences was
catastrophic damage to her kidneys.
She eventually needed a transplant.
Her mother wanted to donate one of her kidneys directly to
her daughter.
There was just one problem.
They weren't compatible.
That is where this story could have become another tragedy
about the limits of medicine.
Instead, healthcare did something smarter.
It found another connection.
Sue Levy Giles entered a paired kidney donor exchange. She
could donate her kidney to another compatible recipient, while Alexandria could
receive a kidney from another donor.
The solution wasn't to force an incompatible match.
It was to redesign the network around the problem.
Alexandria eventually received a transplant, returned to
college, graduated summa cum laude, traveled and began rebuilding her life. She
later met the man who donated the kidney she received.
That story stopped me.
Not because of the transplant alone.
Because of the systems lesson hiding inside it.
When the first path didn't work, healthcare didn't say:
“Sorry. That's the workflow.”
It asked:
“What other path can work?”
Physicians should be asking that question about medical
billing.
Because maybe we have been looking at the wrong problem.
Maybe healthcare doesn't have a billing problem.
Maybe it has a connection problem.
And billing is simply where the broken connections become
expensive.
The kidney wasn't the only thing that needed to match
Think about what happened to Alexandria.
Her mother had something extremely valuable.
Alexandria needed that exact thing.
But the obvious connection failed.
So the healthcare system had to create another route.
That is sophisticated healthcare.
It isn't merely treating a patient.
It is orchestrating people, information, resources,
timing and expertise until the right thing reaches the right person.
Now compare that with the average physician practice.
A patient walks into the office.
The physician evaluates the patient.
A diagnosis is made.
A treatment is provided.
The encounter is documented.
Someone codes it.
Someone submits the claim.
Then the payer says:
“No.”
Maybe because eligibility changed.
Maybe because authorization wasn't documented.
Maybe because a modifier is missing.
Maybe because the documentation doesn't support the
submitted service.
Maybe because the payer has a different interpretation.
Maybe because the information existed in one system but not
another.
Maybe because the claim simply fell into the great
healthcare administrative Bermuda Triangle.
And now someone has to investigate.
Someone has to open a portal.
Someone has to call.
Someone has to send records.
Someone has to resubmit.
Someone has to follow up.
Someone has to remember to follow up again.
And again.
And again.
We call this revenue cycle management.
Sometimes I think we should call it:
“The art of asking six people for information that
already existed somewhere.”
That may sound funny.
Until you're the physician paying for it.
Here's the uncomfortable question
Why are we so comfortable fixing billing problems after
they happen?
We shouldn't be.
In most industries, repeated downstream failure would be
considered a process-design problem.
In healthcare, we often call it:
“just part of billing.”
That phrase should make physicians uncomfortable.
If your practice repeatedly receives the same denial for the
same reason, you don't have a denial problem.
You have a workflow problem.
If staff repeatedly re-enter the same information, you don't
have a staffing problem.
You have a data-flow problem.
If physicians repeatedly have to answer administrative
questions because information wasn't captured correctly the first time, you
don't have a physician problem.
You have a system-design problem.
And if your billing vendor is constantly busy fixing
preventable problems, that doesn't necessarily mean they're doing a great job.
It may mean your system is generating a lot of work.
Busy is not the same as efficient.
The healthcare industry has become very good at creating
middlemen
Here's my contrarian take.
Healthcare doesn't necessarily need more people standing
between the physician and payment.
It needs fewer unnecessary handoffs.
That is different.
I'm not arguing that every billing company should disappear.
I'm not arguing that every administrative employee should be
replaced.
And I'm certainly not arguing that every problem can be
solved with software.
Some human expertise is invaluable.
Some complexity is necessary.
Some payer rules are unavoidable.
But unnecessary complexity is still complexity.
And unnecessary handoffs create opportunities for errors.
Think about the typical journey:
Patient → front desk → EHR → clinician → coder → billing
team → clearinghouse → payer → payer portal → denial queue → billing team →
practice → payer
That's a lot of places for information to get lost.
A small physician-owned practice can spend an extraordinary
amount of energy simply moving information from one place to another.
The physician doesn't see that work.
The patient doesn't see that work.
But somebody pays for it.
Usually the practice.
Alexandria's story offers a better model
The paired kidney exchange is powerful because it doesn't
ask the wrong question.
The wrong question is:
“Can this kidney go directly to this patient?”
The better question is:
“Can we create a network that gets a compatible kidney to
this patient?”
That distinction is everything.
Now apply it to billing.
The traditional question is:
“Why did this claim deny?”
The better question is:
“What happened upstream that made this claim likely to
deny?”
The traditional question is:
“Who will work this account?”
The better question is:
“Why did this account require manual intervention?”
The traditional question is:
“How many claims did we process?”
The better question is:
“How many claims required rework?”
The traditional question is:
“How fast did we resolve the denial?”
The better question is:
“How many similar denials did we prevent?”
That's the shift.
From reactive billing to preventive revenue-cycle
design.
The biggest billing problem may occur before billing
begins
This is the core thesis behind my work as a
physician-founder.
The claim is downstream.
The problem often starts upstream.
Consider a simple example.
A physician performs a procedure.
The clinical work is appropriate.
The patient is eligible.
The physician documents the encounter.
But one required piece of information isn't captured
correctly.
The claim is submitted.
The payer rejects it.
The billing department sees the rejection.
A biller investigates.
The biller contacts the practice.
The practice contacts the physician.
The physician reviews the chart.
The missing information is located.
The claim is corrected.
It goes back.
Eventually it gets paid.
Everyone celebrates.
But should we?
We just spent time from:
- the
biller;
- the
medical assistant;
- the
physician;
- the
practice administrator;
- and
the payer.
All to recover from an error that may have been preventable
at the point of capture.
That isn't revenue-cycle optimization.
That's revenue-cycle archaeology.
Physicians didn't go to medical school to become claims
detectives
Most physicians already know this.
The problem is that they have become remarkably good at
tolerating it.
They tolerate payer portals.
They tolerate prior authorization.
They tolerate documentation requests.
They tolerate denials.
They tolerate inboxes.
They tolerate duplicate data entry.
They tolerate software that requires another software to
explain the first software.
Why?
Because physicians are trained to solve problems.
Give a physician a broken process and eventually they'll
build a workaround.
That's one of medicine's greatest strengths.
It is also one of healthcare's biggest weaknesses.
Because the workaround becomes normal.
Then the workaround becomes policy.
Then the policy becomes workflow.
Then someone builds software around the workflow.
And suddenly we're calling a historical accident “best
practice.”
I question the phrase “best practice”
Healthcare loves the phrase.
Best practice.
It sounds authoritative.
It sounds evidence-based.
It sounds settled.
But sometimes “best practice” simply means:
“This is how we've always done it.”
If your practice has always checked something manually, that
doesn't mean it should remain manual.
If your practice has always outsourced billing, that doesn't
mean outsourcing is automatically optimal.
If your practice has always accepted a certain denial rate,
that doesn't mean the rate is acceptable.
If your staff has always spent Friday afternoon chasing
unpaid claims, that doesn't mean Friday afternoons were designed for that.
Question the workflow.
Respect the people.
Challenge the process.
The numbers matter
A practice owner should know more than total collections.
You need to understand the mechanics underneath the number.
Start with:
Clean claim rate
How many claims leave the practice correctly the first time?
First-pass resolution
How many claims get paid without intervention?
Denial rate
How many claims are rejected?
More importantly:
Why?
Avoidable denial rate
How many failures could reasonably have been prevented?
Days in accounts receivable
How long is earned revenue sitting unpaid?
A/R over 90 days
Old receivables are particularly important because recovery
generally becomes harder as time passes.
Rework rate
How often does someone have to touch the same claim more
than once?
This one deserves more attention.
Because rework is the shadow cost of poor information.
Cost to collect
How much labor and vendor expense are required to turn
billed services into cash?
Manual intervention rate
What percentage of the revenue cycle still requires a human
to move information, check a status or correct something?
These numbers tell a much better story than:
“We processed 25,000 claims this month.”
Congratulations.
How many needed fixing?
The latest kidney story makes the point even more
relevant
This isn't merely an analogy.
There is a larger healthcare movement underway around the
same concept: remove friction between people and lifesaving resources.
On August 27, 2026, HHS announced the winners of the KidneyX
EMPOWER: Living Link Prize Challenge, a $4 million initiative focused on
improving living kidney donation and developing patient-centered solutions.
The KidneyX program describes a stark reality: nearly 100,000
Americans are waiting for a kidney transplant, while living kidney donation
has remained below roughly 7,000 donations annually for years.
The lesson is not simply:
“We need more kidneys.”
It is:
We need better pathways between potential donors and
patients who need them.
That is an innovation problem.
And so is medical billing.
Expert perspective: Dr. Anthony Watkins
Dr. Anthony Watkins, enterprise kidney transplant
director at Jefferson Health, has discussed the profound shortage of kidneys
available for transplantation and the disparities surrounding access.
His perspective adds an important layer to Alexandria's
story.
The healthcare system doesn't operate simply by having
enough medical knowledge.
It also needs the infrastructure to connect resources to
people.
A kidney sitting inside a compatible donor is not yet a
transplant.
A medical service documented in an EHR is not yet revenue.
In both cases, there is a network between the resource and
the outcome.
That network matters.
Expert perspective: Dr. Ezekiel Emanuel
Healthcare policy expert Ezekiel Emanuel, MD, PhD,
has spent years examining healthcare costs, administrative complexity and
payment reform.
One of the broader lessons from that work is that healthcare
cannot meaningfully reduce costs by looking only at clinical care.
Administrative structure matters.
Payment structure matters.
Workflow matters.
The machinery surrounding care matters.
That should be obvious.
But we often talk about healthcare innovation as though the
only interesting thing happens inside the exam room.
It doesn't.
Sometimes the most expensive problem is sitting outside the
exam room.
Expert perspective: Alexandria Warner
Then there is Alexandria herself.
Her perspective may be the most important one.
She described learning, through her transplant experience,
what it actually meant to live on dialysis and wait for a transplant.
That distinction matters.
Healthcare professionals often experience healthcare through
procedures and workflows.
Patients experience it through time.
Waiting.
Calling.
Traveling.
Dialysis.
Appointments.
Recovery.
Uncertainty.
Hope.
That is why operational friction matters.
A five-minute administrative problem for a staff member can
become another week of delay for a patient.
A missing document can become another appointment.
A delayed authorization can become delayed care.
A denied claim may become financial stress for the practice
that provides the care.
Everything is connected.
Here is the paradox of healthcare technology
We have more technology than ever.
And sometimes more administrative work than ever.
That's not because technology doesn't work.
It's because we often digitize the existing process
instead of redesigning the process.
We take paper forms and put them online.
We take phone calls and turn them into portals.
We take manual queues and give them dashboards.
We take spreadsheets and give them cloud storage.
We take repetitive work and put an AI label on it.
But the underlying workflow remains intact.
That's not transformation.
That's digitized bureaucracy.
The better question is:
What work should disappear?
Not:
What work should become digital?
The OnnX thesis
This is why I founded OnnX.
Not because healthcare needs another billing dashboard.
It doesn't.
Not because physicians need another complicated platform.
They don't.
The thesis is simpler:
Medical billing should become more deterministic.
The goal is to reduce unnecessary intermediaries and improve
the quality of information before it becomes a claim.
That means thinking upstream.
Clinical information.
Operational information.
Payer requirements.
Eligibility.
Documentation.
Coding.
Claim construction.
Submission.
Follow-up.
These shouldn't feel like unrelated islands.
They are parts of one financial and clinical workflow.
The better the connections, the less repair work is required
downstream.
What I would do if I owned a small practice today
I wouldn't start by buying new software.
I'd start with ten denied claims.
Just ten.
Put them on a table.
Then ask:
Why did each one fail?
Don't accept:
“Payer issue.”
That's not a root cause.
Ask again.
Was it eligibility?
Authorization?
Coding?
Documentation?
Demographics?
Timely filing?
Coordination of benefits?
Payer configuration?
Missing information?
Then ask the uncomfortable question:
Could this have been prevented?
Now look for repetition.
If five of your ten denials have the same underlying cause,
congratulations.
You just found a process problem.
You don't need a motivational speech.
You need to fix the process.
The five-question physician-owner audit
Try this this week.
1. Where are we losing information?
Follow one claim from the exam room to payment.
2. Where are we re-entering information?
Every duplicate entry is a potential error point.
3. Where are humans acting as bridges between systems?
Those are potential workflow opportunities.
4. Where are claims failing repeatedly?
Don't just fix them.
Find the pattern.
5. What work would disappear if the process were designed
correctly?
That is the question most technology roadmaps forget to ask.
The billing department should become boring
This may be my favorite contrarian idea.
Good billing should be boring.
No drama.
No heroic recovery stories.
No Friday afternoon “emergency denial rescue.”
No celebrating because somebody recovered $40,000 after a
claim sat untouched for four months.
If the same type of failure keeps happening, stop
celebrating the rescue.
Prevent the fire.
A great revenue cycle should feel almost uneventful.
Claims go out.
Clean claims get paid.
Exceptions are surfaced.
Humans handle the exceptions.
Root causes are measured.
Workflows improve.
Repeat.
That's it.
Boring is beautiful.
What about AI?
AI can help.
But let's lower the temperature.
The question isn't:
“Does your billing platform have AI?”
That question is almost meaningless now.
Ask:
What does the AI actually do?
Does it identify missing information?
Does it recognize patterns in denials?
Does it route exceptions?
Does it detect inconsistencies?
Does it reduce manual work?
Does it improve accuracy?
Can a human understand why it made a recommendation?
What happens when it is uncertain?
Those questions matter.
AI should not become another middleman between the physician
and the truth.
It should reduce the number of steps between them.
AI is not a substitute for workflow design
This is particularly important for physician entrepreneurs.
You can build an extraordinary model.
But if the data going into it are incomplete, inconsistent
or poorly structured, the output can be confidently wrong.
That's why I believe data quality comes before AI
sophistication.
Garbage in, garbage out is still true.
Healthcare just has better branding for it now.
The legal problem nobody wants to discuss
Automation doesn't eliminate compliance responsibility.
It can make governance more important.
Medical billing operates within a complicated environment
involving:
HIPAA
protected health information
coding rules
documentation requirements
payer contracts
fraud and abuse laws
false claims considerations
authorization requirements
state and federal requirements
business associate agreements
auditability
If software touches patient information or influences
billing decisions, practices need to understand what the system does.
Who has access?
Where does data go?
What gets stored?
Can actions be audited?
Can a human override a recommendation?
What happens when the system is wrong?
The future of healthcare automation isn't:
human versus machine.
It is:
human judgment + machine assistance + accountable
governance.
Ethical considerations
There is also an ethical issue here.
A physician-owned practice is a business.
Some people become uncomfortable saying that.
They shouldn't.
A practice must generate enough revenue to pay staff,
maintain equipment, invest in care, comply with regulations and remain open.
Financial sustainability is not the enemy of patient care.
It is one of the conditions that makes continued patient
care possible.
The ethical line is elsewhere.
The goal isn't to maximize every dollar at any cost.
The goal is to accurately collect legitimate
reimbursement for legitimate care while protecting patients, maintaining
compliance and minimizing unnecessary administrative burden.
That's a very reasonable goal.
The danger of outsourcing everything
Outsourcing can be useful.
But outsourcing should never mean:
“I have no idea what is happening.”
If you outsource your billing, ask for visibility.
You should know:
What was submitted?
What was accepted?
What was denied?
Why?
What is outstanding?
What is aging?
What is being appealed?
What is being corrected?
What is being prevented?
If the answer to all of those questions is:
“Don't worry. We handle it.”
I'd worry.
The danger of buying another dashboard
Healthcare leaders sometimes respond to complexity by
purchasing visibility.
Then they discover they have:
- an EHR
dashboard;
- a
billing dashboard;
- a
denial dashboard;
- a
payer dashboard;
- an
analytics dashboard;
- an AI
dashboard;
- a
compliance dashboard.
Eventually the physician needs a dashboard to manage the
dashboards.
That is not progress.
Visibility without action is decoration.
The best system tells you:
what happened, why it happened, what matters, and what
should happen next.
Myth Buster
Myth: “Denials are unavoidable.”
Some are.
Preventable recurring denials are not.
Myth: “A busy billing department means the practice has
strong revenue-cycle management.”
No.
A busy department may simply mean the system creates lots of
work.
Myth: “The solution is always more staff.”
Sometimes.
But adding people to a broken process can make the process
more expensive without making it better.
Myth: “AI will eliminate billing problems.”
No.
AI can reduce certain types of work.
It cannot rescue fundamentally poor workflows by itself.
Myth: “Outsourcing removes responsibility.”
No.
It transfers operational work.
It doesn't transfer accountability.
Myth: “The cheapest billing solution is the most
efficient.”
Not if it produces more denials, more rework and more
management overhead.
The metrics I would put on one page
Forget the 47-slide vendor presentation.
Start with:
Clean claim rate
First-pass payment rate
Avoidable denial rate
Days in A/R
A/R over 90 days
Rework rate
Manual intervention rate
Net collection rate
Cost to collect
Time from encounter to clean claim
If you improve these metrics, you are probably improving
something real.
If you only increase the number of claims processed, you may
simply be moving faster in the wrong direction.
A practical 30-day reset
Week 1: Diagnose
Select a representative sample of claims.
Identify the top five failure reasons.
Don't buy anything.
Just learn.
Week 2: Map
Trace each failure upstream.
Where did the problem begin?
Where was it first visible?
Where could it have been prevented?
Week 3: Fix
Choose one recurring failure.
Change the workflow.
Train the team.
Automate where appropriate.
Week 4: Measure
Compare the baseline with the new process.
Did the failure decrease?
Did staff time decrease?
Did clean claims increase?
Did the practice collect faster?
If not, change course.
This is not glamorous.
It works anyway.
What healthcare founders should learn from Alexandria
Warner
If you're building healthcare technology, don't start with
the technology.
Start with the broken connection.
Ask:
What is the patient trying to accomplish?
Where does the journey break?
Who currently acts as the bridge?
Why?
What information is missing?
What creates delay?
What work is repetitive?
What requires judgment?
What can be automated?
What must remain human?
And perhaps the most important question:
What happens if we do nothing?
Healthcare founders sometimes build solutions for problems
that are annoying.
The best companies solve problems that are expensive,
persistent and painful.
Administrative friction qualifies.
But only if you solve the actual friction.
Not the symptom.
What physicians should demand from healthcare technology
Don't be impressed by features.
Ask for outcomes.
Show me the reduction in manual work.
Show me the improvement in clean claims.
Show me the reduction in avoidable denials.
Show me the time saved.
Show me how exceptions are handled.
Show me the audit trail.
Show me what happens when the system is wrong.
And then ask:
Can my staff actually use this?
The most sophisticated technology in the world is worthless
if the practice hates using it.
The future is not fully automated healthcare
I don't think that's the goal.
The future should be better coordinated healthcare.
Humans should do what humans are good at.
Machines should do what machines are good at.
Systems should connect them.
That is the lesson I take from Alexandria's story.
Her mother's kidney wasn't the wrong resource.
It simply wasn't the right match.
The solution was not to blame the kidney.
The solution was to build a better network.
Healthcare billing deserves the same mindset.
The deeper lesson: stop fixing the last mile
We spend enormous energy repairing problems at the end of
the process.
The denial.
The rejected claim.
The unpaid balance.
The missing document.
The payer request.
The appeal.
The phone call.
The fax.
The portal.
The spreadsheet.
The reminder.
The follow-up.
The second follow-up.
The third follow-up.
But the last mile is often where the problem becomes
visible.
It isn't necessarily where the problem begins.
Fix upstream.
That is where the leverage is.
What Alexandria's mother understood instinctively
Sue Levy Giles wanted to help her daughter.
The direct path didn't work.
She didn't conclude that helping was impossible.
She accepted that the path had to change.
That is an extraordinary lesson for healthcare leaders.
Sometimes the most dangerous sentence in healthcare is:
“That's just how it works.”
No.
That's how it works today.
There is a difference.
Final Thoughts: Healthcare doesn't need more heroic work
It needs fewer situations requiring heroes.
We celebrate the biller who recovers a huge claim.
The nurse who stays late.
The physician who finishes charts at midnight.
The administrator who fixes the payer mess.
The transplant team that solves the impossible match.
Those people deserve recognition.
But there is another kind of excellence.
Designing the system so the heroic intervention is needed
less often.
That's where healthcare should be going.
Alexandria Warner needed a kidney.
Her mother, Sue Levy Giles, wanted to give her one.
The direct path failed.
Healthcare found another path.
That is what good systems do.
They don't confuse the first failed connection with the end
of the journey.
They redesign the connection.
For physician-owned practices, the same principle applies.
When a claim fails, don't simply work harder.
Ask why.
When staff are overwhelmed, don't automatically hire more
people.
Ask where the work comes from.
When technology creates more complexity, don't buy another
tool.
Ask whether the complexity itself should exist.
When a billing process requires constant human rescue, don't
celebrate the rescues.
Redesign the process.
The future of healthcare won't be won by whoever adds the
most technology.
It will be won by whoever removes the most unnecessary
friction without removing the humanity from care.
And that is why a story about one woman, one mother and one
kidney is actually a story about the future of medical practice.
The best healthcare systems don't merely have more
resources.
They make better connections between the resources they
already have.
Maybe it's time we did the same with medical billing.
Get Involved
Here is the question I want to leave with physicians and
clinic owners:
What is the one administrative process in your practice
that everyone has accepted as “normal” even though you know it is unnecessarily
complicated?
Is it billing?
Denials?
Prior authorization?
Eligibility?
Documentation?
Referrals?
Payer portals?
A/R follow-up?
Or something else?
Tell me in the comments.
I am particularly interested in the problems physicians have
stopped complaining about because they have simply learned to live with them.
Share this article with another physician or clinic owner
who spends too much time fixing administrative problems that should have been
prevented upstream.
And if you believe physician-owned practices deserve better
infrastructure, get involved.
Ask harder questions.
Challenge “best practices.”
Share what works.
Share what fails.
Help move healthcare from reactive administration toward
intelligent, connected workflows.
Don't just accept the broken connection.
Find it.
Fix it.
Build something better.
About the Author
Dr. Daniel Cham is a physician, healthcare technology
consultant and entrepreneur focused on the intersection of medical practice,
healthcare operations, medical billing and artificial intelligence.
He is the founder of OnnX, an AI-powered medical
billing SaaS focused on reducing unnecessary intermediaries and helping small
and medium-sized physician-owned practices improve revenue-cycle workflows.
His work focuses on a practical question:
How can technology give clinicians more time to practice
medicine instead of creating more administrative work?
Connect with Dr. Daniel Cham on LinkedIn:
Disclaimer
This article is intended for general educational and
informational purposes only. It does not constitute medical, legal,
compliance, financial or professional advice. Healthcare organizations and
professionals should consult appropriately qualified experts regarding their
individual clinical, legal, regulatory, billing, technology and operational
circumstances.
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Three Current References
Alexandria Warner and Sue Levy Giles — WHYY
WHYY's current report tells the human story of Alexandria
Warner's kidney failure after a devastating crash, her mother's desire to
donate directly, their incompatibility, and the paired-donor pathway that
ultimately helped Alexandria receive a transplant.
HHS KidneyX EMPOWER — Living Kidney Donation
HHS announced the 2026 KidneyX EMPOWER winners on August 27,
highlighting a $4 million initiative designed to address barriers to living
kidney donation and advance patient-centered innovation.
KidneyX — Living Donation Challenge
KidneyX describes the larger problem: nearly 100,000
Americans are currently waiting for kidney transplantation, while living kidney
donation has remained below approximately 7,000 annually.
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#RevenueCycleManagement #PhysicianEntrepreneur #PhysicianLeadership
#MedicalPractice #HealthcareOperations #IndependentPhysicians #ClinicOwners
#DigitalHealth #HealthTech #HealthcareTransformation #PatientCenteredCare
#KidneyTransplant #OrganDonation #HealthEquity #HealthcareLeadership
#PracticeManagement #AIinHealthcare #RevenueCycle #MedicalPracticeManagement
#PhysicianOwnedPractice #FutureOfHealthcare
