When the normal system fails, great healthcare leaders don't accept the failure—they redesign the path forward. The same principle could transform medical billing.
“Many physicians fear the health insurance industry’s use
of unregulated artificial intelligence (AI) automation and predictive
technologies will increasingly override good medical judgment and
systematically deny patients coverage for necessary medical care.” — American
Medical Association
There are stories about healthcare that make you think.
And then there are stories that make you stop scrolling.
On September 11, 2001, the United States stopped flying.
Airspace was shut down. Airports were closing. The country
was trying to understand an unfolding catastrophe.
In Houston, however, a six-month-old baby named Kareena
had a much more immediate problem.
She was suffering from liver failure.
A compatible donor liver was waiting in Nashville,
Tennessee.
The liver needed to reach Houston.
Normally, that would mean putting an organ on an airplane.
But September 11 was not a normal day.
There was no ordinary flight.
No ordinary airport.
No ordinary logistics.
And no room for an ordinary excuse.
That was when Jill Grandas, then working in organ
donation at Tennessee Donor Services, started making calls.
She contacted air-traffic officials and began asking a
question that, under the circumstances, must have sounded almost absurd:
Could they get a lifesaving organ through a country whose
airspace had been grounded?
Eventually, the answer was yes.
A Tennessee National Guard C-130 was cleared to fly.
The donor liver made its way from Nashville to Houston.
Dr. John Goss and the transplant team at Texas
Children's Hospital were waiting.
Former transplant surgeon and then-Senator Bill Frist, MD,
also became involved in helping facilitate the effort.
The organ arrived.
Kareena received her transplant.
She lived.
Twenty-five years later, in 2026, Jill Grandas and Kareena
finally met in person.
Kareena is now 25 years old, in law school, and interested
in health policy and the social determinants of health.
Think about that for a moment.
A six-month-old child.
A donor family experiencing unimaginable grief.
A nurse making phone calls.
An air-traffic system operating under extraordinary
conditions.
A military aircraft.
A transplant team.
A surgeon.
A senator.
An organ traveling across several states.
And one little girl whose future depended on all those
moving parts working together.
That is not just a transplant story.
It is a story about coordination.
And that is why I think physicians and medical practice
owners should pay attention.
Because healthcare has not stopped being a coordination
problem.
We have simply become better at hiding the coordination
problem behind software, portals, forms, passwords, phone trees, spreadsheets,
faxes, clearinghouses, billing companies, payer rules, work queues, denial
queues, and people saying:
“That's just how healthcare works.”
I disagree.
And I think independent physicians should disagree, too.
Because there is a dangerous idea hiding inside that
sentence.
It is the idea that complexity is inevitable just because
it is familiar.
It isn't.
Sometimes complexity is necessary.
Sometimes it is merely accumulated.
And medical billing has accumulated a lot.
The Uncomfortable Question
Let me ask a question that may irritate a few people in
revenue-cycle management:
Why does a physician who successfully diagnoses and
treats a patient need an entire administrative ecosystem to convince another
organization to pay for the work?
The standard answer is:
“Because healthcare is complicated.”
True.
But incomplete.
Healthcare is complicated because medicine is complicated.
Medical billing is complicated because we built it that
way, layered rules on top of rules, and then hired people to manage the
resulting mess.
Those are not the same thing.
A physician can perform an intricate procedure with
extraordinary precision.
Then the claim can fail because a modifier was missing.
The patient receives the care.
The practice receives the headache.
The payer receives another phone call.
The biller opens another portal.
Someone sends another fax.
Another spreadsheet gets updated.
And eventually someone says:
“We need more staff.”
Maybe.
Or maybe we need a better system.
That distinction matters.
Because hiring more people to compensate for broken
processes can create the illusion of improvement while preserving the
underlying problem.
It is the healthcare equivalent of putting a second person
in the passenger seat because the first person cannot find the brakes.
The Kareena Test
I call this the Kareena Test.
Imagine that the six-month-old Kareena's liver had been
sitting in Nashville on September 11, 2001, and someone had responded:
“Unfortunately, our normal transportation workflow is
unavailable.”
That would have been technically true.
It also would have been completely unacceptable.
The people involved did something different.
They did not confuse the failure of the normal process with
the impossibility of the mission.
They asked:
What is the mission?
Save the child's life.
Then:
What is preventing the mission?
The airspace shutdown.
Then:
What can we change?
The transportation method.
That is operational thinking.
And it is desperately needed in medical practices.
The mission of a medical practice is not:
- submit
claims;
- work
denials;
- check
eligibility;
- upload
documentation;
- reconcile
remittances;
- answer
payer requests;
- maintain
spreadsheets.
Those are activities.
The mission is care.
Revenue is what allows the practice to continue delivering
that care.
Billing is infrastructure.
The mistake is treating infrastructure as clerical trivia.
Here's My Contrarian Take
Your billing department should not be measured primarily
by how busy it is.
That may sound obvious.
It isn't.
Healthcare has a strange tendency to reward activity.
More calls.
More notes.
More work queues.
More claims touched.
More denials appealed.
More staff.
More vendors.
More meetings about the meetings.
We can become incredibly efficient at doing unnecessary
work.
That is not operational excellence.
That is organized exhaustion.
The real question is:
How much human intervention does it take to turn one
legitimate clinical encounter into accurate, timely payment?
That is a much more interesting metric.
And a much more uncomfortable one.
Because if a clean claim requires six manual touches, three
portals, two phone calls, one spreadsheet, and someone who knows the payer's
secret handshake, the problem may not be that your billing staff is
underperforming.
The problem may be that your system is.
The Numbers Are Becoming Difficult to Ignore
This is not merely a philosophical argument.
The administrative burden around healthcare is measurable.
The AMA's latest physician survey found that physicians
complete an average of 40 prior authorizations each week, consuming
approximately 13 hours of physician and staff time. Ninety-five percent
reported that prior authorization delays necessary care, while 79% said
authorization challenges can lead patients to abandon treatment. Twenty-six
percent reported that prior authorization had contributed to a serious adverse
event for a patient in their care.
Those numbers are about prior authorization, not medical
billing specifically.
But they expose the larger problem:
Healthcare is spending enormous amounts of human
intelligence navigating administrative friction.
And we should stop pretending that friction is free.
It isn't.
It comes out of:
- physician
time;
- staff
time;
- patient
access;
- practice
margins;
- employee
morale;
- investment
in technology;
- clinical
capacity.
And eventually, it comes out of the patient's experience.
The AMA reported this month that from 2001 through 2026, the
cost of running a medical practice increased substantially faster than Medicare
physician payment. The AMA says practice costs rose 63% over that period while
Medicare physician payment rose only 10%, representing a 33% inflation-adjusted
decline in physician payment.
That creates a brutal operating environment for independent
practices.
Costs rise.
Payment pressure rises.
Administrative complexity rises.
And the physician is somehow expected to smile through all
of it.
That is not a business model.
That is a stress test.
The Great Medical Billing Myth
There is a myth in healthcare that sounds reasonable:
“If you want your revenue cycle to perform, outsource it
to experts.”
Sometimes that's exactly the right decision.
I'm not anti-outsourcing.
I'm anti-outsourcing without visibility.
There is a difference.
A good billing partner can bring expertise, staffing, scale,
payer knowledge, and disciplined processes.
But outsourcing a process does not eliminate your
responsibility for the outcome.
If a physician-owner cannot answer basic questions such as:
- What
percentage of our claims are rejected?
- Why
are they rejected?
- How
long do they sit before being corrected?
- Which
payers create the most friction?
- What
is our denial rate?
- How
much is sitting in A/R?
- How
old is that A/R?
- What
percentage of claims are being submitted cleanly?
- Which
codes generate recurring problems?
- How
much revenue is being written off?
- What
is actually collectible?
then the practice does not have a revenue-cycle strategy.
It has a revenue-cycle mystery.
And mystery is a terrible financial control system.
The Middleman Problem Is More Subtle Than It Looks
There is another provocative idea worth considering.
Physicians often say:
“I don't want a billing middleman.”
I understand the sentiment.
But the real problem isn't simply the existence of a
middleman.
The real problem is the absence of transparent
accountability between the work and the result.
A billing company can be valuable.
A clearinghouse can be valuable.
A coding specialist can be valuable.
A software platform can be valuable.
An AI system can be valuable.
The problem begins when every additional layer makes it
harder for the practice owner to understand what happened.
Think about the difference between these two statements:
“Our billing company handles it.”
and:
“We submitted 4,812 claims last month. Ninety-six percent
passed initial validation. The remaining 4% were categorized by root cause. We
know which payer caused the most friction, which codes generated the most
rework, and which claims remain unresolved.”
The second statement represents control.
The first represents delegation.
Delegation is not the same thing as control.
Jill Grandas Didn't Have a Perfect Workflow
This may be the most interesting part of the Kareena story.
Jill Grandas did not have a 27-page emergency organ
transportation SOP waiting on her desk.
She didn't open a dashboard showing:
“National Airspace Shutdown — Exception Workflow #47.”
She had a problem.
She had a patient whose window was closing.
And she started calling people.
That is not an argument against technology.
It is an argument for technology that understands the
mission rather than merely digitizing the paperwork.
Technology should not make a broken process prettier.
It should make the process better.
There is a difference.
A PDF uploaded to a portal is still a PDF.
A spreadsheet moved into the cloud is still a spreadsheet.
A manual billing workflow displayed on a dashboard is still
manual.
Putting lipstick on administrative friction does not turn it
into innovation.
What Physicians Should Actually Automate
The answer is not:
“Automate everything.”
That is another fashionable oversimplification.
The better question is:
What should humans decide, and what should machines
reliably detect, route, reconcile, and execute?
Humans are good at:
- clinical
judgment;
- exceptions;
- relationships;
- ambiguity;
- ethical
decisions;
- complex
payer disputes;
- interpreting
unusual circumstances.
Machines are good at:
- pattern
recognition;
- repetitive
validation;
- checking
consistency;
- identifying
missing information;
- comparing
large datasets;
- routing
work;
- monitoring
thresholds;
- detecting
anomalies;
- producing
alerts;
- repetitive
reconciliation.
The future of medical billing should not be:
humans versus AI.
It should be:
humans doing the work that requires humans.
That sounds simple.
Healthcare has somehow made it revolutionary.
The Seven-Step Billing Reset
If I were sitting down with a physician-owner tomorrow and
we wanted to understand whether their revenue cycle was healthy, I would not
start by asking which billing vendor they use.
I would start here.
Step 1: Follow One Claim
Take one real claim.
Follow it from:
appointment → registration → documentation → coding →
claim creation → clearinghouse → payer → adjudication → payment →
reconciliation.
Do not rely on someone's explanation.
Watch the actual journey.
You will probably find something interesting.
You may find three systems.
You may find five.
You may find a human manually moving information from one
system to another.
You may discover that nobody actually owns a particular
handoff.
That is valuable information.
Because you cannot improve what you cannot see.
Step 2: Build a Denial Taxonomy
Stop using “denials” as one giant bucket.
Separate them.
For example:
- eligibility;
- authorization;
- coding;
- modifier;
- documentation;
- medical
necessity;
- timely
filing;
- demographic;
- payer
policy;
- duplicate;
- coordination
of benefits;
- technical
rejection.
Then ask the uncomfortable question:
Which denial category is predictable?
Predictable problems should not remain permanent problems.
If the same payer denies the same service for the same
reason every month, you do not have a denial problem.
You have a process-design problem.
Step 3: Measure Rework
This is one of the most neglected metrics in healthcare.
How many claims require somebody to touch them more than
once?
How many require:
- correction;
- resubmission;
- phone
calls;
- documentation
retrieval;
- manual
review;
- payer
portal intervention?
Revenue-cycle leaders often report collections.
Good.
But also measure rework.
Because rework is where margin goes to die quietly.
Step 4: Measure Time to Resolution
A denial that is resolved in two days is different from a
denial that sits for 60 days.
Track:
Date denied → date resolved.
Then segment it.
By payer.
By reason.
By service.
By location.
By provider.
By staff member if appropriate.
Patterns will emerge.
And patterns create leverage.
Step 5: Separate Technology From Theater
Ask every vendor:
What manual work disappears?
Not:
“What does your dashboard look like?”
Not:
“How sophisticated is your AI?”
Not:
“How many integrations do you have?”
Ask:
What human steps disappear?
If the answer is unclear, keep asking.
Healthcare does not need more technology theater.
It needs measurable reductions in unnecessary work.
Step 6: Create an Exception Queue
Automation should not mean pretending every claim is
identical.
It means the normal cases move normally.
The unusual cases get attention.
That is the principle behind an exception-based revenue
cycle.
Instead of humans checking everything, humans investigate
what the system identifies as unusual.
That is where AI can become genuinely useful.
Not because it sounds futuristic.
Because it changes the economics of attention.
Step 7: Put the Physician Back in the Control Room
Physicians should not be manually billing claims.
But they should understand their revenue cycle.
There is a difference.
You don't need to become a professional biller.
You need enough visibility to run your practice.
A physician-owner should know:
What happened to the work we performed?
That is not greed.
It is governance.
Three Experts. Three Lessons.
1. Willie Underwood III, MD, MSc, MPH: Stop Accepting
Administrative Friction as Normal
The current AMA president has been unusually direct about
the consequences of administrative barriers.
His recent message is simple: patients should not have to
fight the healthcare system to receive necessary care. He also points to the
enormous time burden created by prior authorization and argues that voluntary
promises are insufficient without meaningful accountability.
The lesson for practice owners:
If a process repeatedly consumes physician and staff time
without improving patient care or financial accuracy, it deserves scrutiny.
Not another meeting.
Scrutiny.
2. The AMA's Physician Survey: Measure the Hidden Tax
The latest data give us something more useful than
anecdotes.
Forty prior authorizations per week.
Approximately 13 hours.
Ninety-five percent reporting delays.
Seventy-nine percent reporting treatment abandonment tied to
authorization challenges.
Twenty-six percent reporting serious adverse events
connected to prior authorization.
The lesson:
Administrative burden is not a soft issue.
It is an operational metric.
3. ONC: The Infrastructure Is Moving Toward More
Interoperability
The federal health IT environment is also moving toward
greater standardization and electronic exchange.
Recent federal work around electronic prior authorization
and payer-provider data exchange points toward more structured interoperability
rather than endless dependence on disconnected manual workflows.
The lesson:
The direction of travel is toward machine-readable
healthcare administration.
That creates an opportunity.
But only if practices are willing to redesign workflows
rather than simply connect another application to the existing mess.
Recent News: Healthcare Is Having an Administrative
Reckoning
Three developments are worth watching.
Medicare payment pressure
The AMA's September 4 analysis of the proposed 2027 Medicare
Physician Fee Schedule highlights ongoing payment pressures and policy changes
physicians will need to understand.
Prior authorization reform
Congress is considering bipartisan reforms intended to
reduce administrative burdens and improve transparency around Medicare
Advantage prior authorization. The AMA continues to push for enforceable
standards rather than voluntary commitments.
Denials are becoming a policy issue, not merely a billing
issue
A recent AMA report highlighted federal findings that, in
certain Medicare Advantage settings, some prior authorization denials were
overturned at extremely high rates when appealed.
The larger signal is clear.
Administrative friction is moving from the back office into
the center of healthcare policy.
Physicians should pay attention.
The Hidden Cost of “Normal”
Here is a thought that I wish more practice owners would
write on a whiteboard:
Normal does not mean healthy.
A 30-day A/R cycle may be normal.
That doesn't mean it is good.
A certain percentage of denials may be normal.
That doesn't mean they are acceptable.
Manual eligibility verification may be normal.
That doesn't mean it should remain manual.
Billing staff spending hours navigating payer websites may
be normal.
That doesn't mean the workflow is well designed.
Physicians have inherited thousands of operational habits
from previous generations.
Some are necessary.
Some are simply historical artifacts.
The healthcare industry has an unfortunate habit of
confusing legacy with wisdom.
What I Got Wrong
There is another reason I believe this conversation needs
honesty.
Healthcare technology companies—including companies working
on AI and revenue cycle management—can easily fall into the same trap they
claim to solve.
I have seen the temptation firsthand.
Build more features.
Add more automation.
Add another dashboard.
Add another integration.
Talk about AI.
Talk about scale.
Talk about transformation.
Meanwhile, the physician is still asking:
“Why didn't this claim get paid?”
That is the failure.
Technology should be judged by outcomes, not vocabulary.
If AI cannot explain what it changed, why it changed it, and
whether the change improved the process, then “AI-powered” may be little more
than a marketing adjective.
That is not innovation.
That is branding.
The OnnX Perspective
This is where my own work comes into the conversation.
As a physician and medical technology consultant, I have
spent time thinking about the gap between what healthcare technology promises
and what medical practices actually experience.
That gap is enormous.
Physicians do not need another system that asks them to
become software administrators.
They need infrastructure that reduces unnecessary friction.
That thinking is part of why I am building OnnX
around an AI-powered approach to medical billing for small and medium-sized
medical practices.
The philosophy is straightforward:
The practice should own the relationship with its
revenue.
Technology should improve visibility.
Automation should reduce repetitive work.
AI should identify patterns and exceptions.
The physician-owner should not need to become a billing
expert to understand what is happening.
And the goal should never be “replace everyone.”
The goal should be:
remove unnecessary work so the people who remain can do
higher-value work.
That distinction matters.
Because the future of healthcare is not a world without
humans.
It should be a world where humans are no longer wasting
their best hours doing work machines can reliably handle.
Why Small Practices Have More to Lose
Large health systems can absorb inefficiency differently.
They have departments.
Analysts.
Compliance teams.
Revenue-cycle executives.
IT teams.
Legal departments.
Data teams.
Small practices do not have that luxury.
The physician may also be:
- owner;
- clinical
leader;
- employer;
- recruiter;
- negotiator;
- compliance
decision-maker;
- technology
buyer;
- financial
decision-maker.
And sometimes the physician is still expected to worry about
why a claim was rejected because someone entered the wrong payer ID.
That is absurd.
Not because billing is unimportant.
Because physician attention is expensive.
Every hour a physician spends fighting administrative
friction is an hour that could have been spent on patients, leadership, growth,
teaching, innovation, or simply going home before dinner.
The Ethical Question
There is also an ethical dimension here.
When administrative systems become excessively complicated,
the burden does not fall evenly.
Patients with time, money, education, transportation,
digital access, and persistent advocates may navigate them better.
Patients without those resources may not.
The same is true inside medical practices.
A large organization may be able to absorb another
administrative requirement.
A two-physician clinic may not.
So when we talk about administrative simplification, we are
not merely talking about convenience.
We are talking about access.
If administrative friction makes certain practices
economically unsustainable, patients may lose access to those physicians.
If physicians stop accepting certain insurance because
reimbursement and administrative burden no longer make the practice viable, the
patient experiences that as a shortage of access.
That is why revenue-cycle management is not merely finance.
It is healthcare infrastructure.
The Legal and Compliance Reality
Technology does not eliminate legal responsibility.
Neither does outsourcing.
Neither does AI.
Practices remain responsible for complying with applicable
laws, payer contracts, coding rules, documentation requirements, privacy
obligations, and other regulatory requirements.
Automation therefore needs controls.
You want:
- auditability;
- traceability;
- role-based
access;
- appropriate
documentation;
- human
review for high-risk exceptions;
- clear
escalation pathways;
- monitoring;
- validation;
- appropriate
security controls.
The worst possible AI billing system would be one that makes
incorrect decisions faster and hides why it made them.
Speed without accountability is not innovation.
It is accelerated risk.
Five Questions Every Physician-Owner Should Ask a Billing
Vendor
Before signing another agreement, ask:
1. Where exactly does my revenue go after the claim
leaves my practice?
If nobody can explain the workflow clearly, that's a
problem.
2. What percentage of claims require manual intervention?
Do not accept vague answers.
Ask for the definition.
3. What are my top five denial causes?
If your vendor cannot tell you, you do not have enough
visibility.
4. How quickly do you identify a preventable pattern?
If the same denial appears for six months, why?
5. What work can you eliminate rather than merely
outsource?
That is the most important question.
Because moving work from your employee to a vendor is not
the same as eliminating the work.
Metrics That Actually Matter
A practice dashboard should not become a Christmas tree of
meaningless KPIs.
Focus on a small number of useful measures.
Clean claim rate
How many claims pass initial submission without avoidable
correction?
First-pass resolution
How many claims are resolved without additional
intervention?
Denial rate
How often are claims denied?
Denial root cause
Why?
Days in A/R
How long does money remain outstanding?
A/R aging
How much is older than 30, 60, 90, or 120 days?
Rework rate
How many claims require repeated intervention?
Time to resolution
How quickly do exceptions get resolved?
Net collection performance
How much collectible revenue actually becomes cash?
And one metric I would add more often:
Human touches per claim.
Because if that number keeps falling while financial
performance remains stable or improves, something important is happening.
The system is becoming smarter.
Myth Buster: Medical Billing Edition
Myth: “More billing staff automatically means better
collections.”
Not necessarily.
More staff can compensate for bad processes.
It can also make bad processes more expensive.
Myth: “Outsourcing means I no longer need to understand
billing.”
Wrong.
You don't need to perform billing.
You do need to understand the financial engine of your
practice.
Myth: “AI means fully autonomous billing.”
Not necessarily.
Responsible automation should include validation, exception
handling, oversight, and auditability.
Myth: “Every denial should be appealed.”
No.
Some denials are worth correcting.
Some are not.
The goal is not maximum activity.
It is maximum economic and clinical value.
Myth: “A dashboard means I have transparency.”
Only if the data are accurate, timely, understandable, and
actionable.
A beautiful dashboard displaying bad information is still
bad information.
Myth: “Healthcare is too complicated to simplify.”
Some of healthcare is genuinely complicated.
But complexity should be earned.
Every unnecessary step should be challenged.
Five Pitfalls to Avoid
1. Automating a broken process
First understand the workflow.
Then redesign it.
Then automate.
Not the other way around.
2. Measuring activity instead of outcomes
A busy billing team is not necessarily a successful billing
team.
3. Treating every payer identically
Payer behavior differs.
Your data should reveal those differences.
4. Making AI decisions invisible
If nobody can explain why the system acted, you have created
a governance problem.
5. Removing humans from exceptions
The goal should be to remove humans from repetitive work—not
from judgment.
What the Kareena Story Really Teaches Us
The obvious lesson from the 9/11 liver story is courage.
There is another lesson that interests me more.
Systems are made of people.
When the usual system failed, people connected.
Jill Grandas called.
Someone answered.
Someone made another call.
Someone found a path through the airspace restrictions.
A military aircraft moved.
A transplant team prepared.
A surgeon waited.
A donor family gave.
A child lived.
The extraordinary outcome came from ordinary people
coordinating extraordinarily well.
That is the part healthcare technology should preserve.
Not the heroics.
The coordination.
Imagine a medical practice where:
The appointment creates the appropriate administrative data.
Eligibility is verified.
Documentation is checked.
Coding is validated.
The claim is prepared.
Potential problems are identified before submission.
The payer response is monitored.
Exceptions are routed.
Denials are categorized.
Patterns are identified.
The practice owner can see the financial picture.
And humans intervene where judgment is actually necessary.
That doesn't sound revolutionary.
It sounds normal.
Exactly.
Maybe the revolution in healthcare is simply making the
normal process work.
The Future Is Not “More AI”
This is another contrarian point.
I don't think the future belongs to companies with the most
AI.
It belongs to companies that understand where AI actually
creates leverage.
Healthcare has already accumulated enough software.
What it lacks is enough coherence.
The next generation of healthcare technology should
therefore compete on:
- fewer
manual steps;
- better
interoperability;
- clearer
accountability;
- faster
exception detection;
- better
auditability;
- lower
administrative burden;
- better
financial visibility;
- measurable
outcomes.
The technology should become less noticeable.
That is often what good infrastructure does.
You don't celebrate electricity every morning.
You simply expect the lights to work.
Medical billing should eventually feel more like
infrastructure and less like detective work.
A Different Definition of Innovation
For years, healthcare innovation has been associated with
dramatic things:
Robotics.
Genomics.
Virtual reality.
Precision medicine.
Large language models.
Wearables.
Digital twins.
All fascinating.
But there is another kind of innovation.
Making an ordinary process dramatically less painful.
If an independent physician can spend less time chasing
claims and more time practicing medicine, that is innovation.
If a medical biller can manage exceptions instead of
manually inspecting every transaction, that is innovation.
If a practice owner can see exactly where revenue is getting
stuck, that is innovation.
If a patient never notices that a complicated administrative
problem was resolved before it affected them, that may be the best innovation
of all.
What I Would Do If I Owned a Small Practice Today
I would not start by buying another tool.
I would start with an audit.
Monday
Pull the last 90 days of claims.
Tuesday
Categorize denials.
Wednesday
Identify the top five recurring causes.
Thursday
Calculate the human work required to resolve them.
Friday
Choose the three highest-value processes to redesign.
Then I would ask:
Can this be prevented?
If yes, prevent it.
Can this be automated?
If yes, automate it.
Can this be standardized?
If yes, standardize it.
Does this require human judgment?
If yes, route it to a human.
That simple framework can be more powerful than buying
another platform because it starts with the problem rather than the product.
The Physician-Owner's New Job
Being a physician-owner used to be difficult enough.
Now the physician-owner increasingly needs to understand
technology, operations, finance, workforce strategy, payer behavior, and
regulatory change.
That does not mean physicians need to become MBAs.
It means physicians need to stop outsourcing understanding.
You can outsource execution.
You can outsource specialized expertise.
You can outsource technology infrastructure.
But you cannot outsource accountability for the business you
own.
At least not if you want to remain independent.
The Question I Would Ask the Industry
Here is my challenge to the medical billing industry:
If AI is becoming dramatically better at processing
information, why are so many healthcare organizations still organized around
humans manually moving information from one system to another?
And to physician-owners:
Why are you paying people to compensate for processes
that technology should be preventing?
And to technology companies:
Can you prove that your product removes work, rather than
simply relocating it?
And to myself:
Can I build something that actually answers those
questions?
That is the standard I believe healthcare technology should
face.
Practical Resources
For physicians and practice owners who want to go deeper,
three resources are especially relevant right now.
American Medical Association — Prior Authorization and
Practice Management
The AMA continues to publish physician-focused research and
operational guidance around prior authorization, payment, revenue cycle, and
administrative burden.
Explore
AMA practice-management resources
American Medical Association — 2027 Proposed Medicare
Physician Fee Schedule
The AMA's September 2026 analysis explains important
provisions in the proposed 2027 Medicare physician payment rule.
Read
the AMA Medicare payment analysis
Office of the National Coordinator for Health IT
ONC resources are useful for practices and technology
leaders following the transition toward more standardized electronic health
information exchange and administrative interoperability.
Explore ONC health IT
resources
Tools Worth Having
You don't need 27 applications.
You need the right visibility.
At minimum:
A practice-management system for core operational and
financial data.
A clearinghouse for claim transmission and electronic
transactions.
An eligibility workflow that reduces manual
verification.
A denial-management process with root-cause
classification.
A dashboard that exposes A/R, denials, payment
trends, and exceptions.
An audit trail for automated decisions.
An AI layer, where appropriate, to identify patterns
and reduce repetitive work.
The architecture matters less than the result.
The question is always:
Does this make the practice easier to run?
The Most Important Metric May Be Attention
We talk about revenue.
We talk about collections.
We talk about denial rates.
We talk about productivity.
But I think healthcare needs another metric:
attention.
How much physician attention does the administrative system
consume?
How much staff attention?
How much patient attention?
How much management attention?
Because attention is finite.
A physician has only so many hours.
A practice manager has only so many hours.
A biller has only so many hours.
The objective should not be to squeeze more work into those
hours.
It should be to eliminate work that never needed to happen.
That is a very different philosophy.
The Beautiful Irony of the 9/11 Liver Story
There is something almost ironic about this story.
In one of the most technologically and operationally
sophisticated countries on Earth, a lifesaving medical mission ultimately
depended on a nurse making a phone call.
Not an app.
Not an AI model.
Not a dashboard.
A phone call.
And yet that should not lead us to conclude that technology
is overrated.
It should lead us to ask a better question:
Why did the human being have to carry so much of the
coordination burden?
Today we have technologies capable of analyzing millions of
transactions.
We can predict patterns.
We can automate workflows.
We can exchange structured data.
We can build intelligent systems.
So why are people still spending hours chasing information
that machines could organize?
Because healthcare technology has often digitized the surface
of the workflow without redesigning the system underneath it.
That is the opportunity.
One Last Thought About Kareena
Kareena was six months old when her life depended on a chain
of strangers refusing to accept that the normal route was impossible.
She is now 25.
She is studying law.
She is thinking about health policy.
That is what a successful healthcare system is ultimately
supposed to produce.
Not more claims.
Not more dashboards.
Not more billing reports.
More tomorrows.
Every claim is attached to a clinical encounter.
Every payment supports a practice.
Every functioning practice supports patients.
And every unnecessary administrative burden takes something
away from that chain.
Sometimes money.
Sometimes time.
Sometimes morale.
Sometimes access.
Sometimes trust.
The industry has spent years asking how to collect more
money from healthcare.
Maybe the better question is:
How do we remove the friction that prevents healthcare
from functioning the way it should?
That is a harder question.
But it is the right one.
Get Involved
I want to leave physician-owners, practice administrators,
medical billers, healthcare operators, and technology leaders with one
uncomfortable question:
If you could eliminate one unnecessary step from the
medical billing process tomorrow, what would it be?
Not add.
Not optimize.
Not automate.
Eliminate.
Tell me in the comments.
I am especially interested in hearing from physicians and
practice administrators who are still dealing with manual workflows, recurring
denials, payer friction, fragmented systems, or poor visibility into their
revenue cycle.
And if you know a physician-owner who needs to see this
conversation, share or repost this article with them.
The healthcare system does not need another conversation
about how complicated healthcare is.
It needs more conversations about what we are willing to
stop accepting.
Final Thoughts
Stop measuring how hard your team works. Start measuring
how much unnecessary work your system creates.
Stop treating administrative friction as the price of
practicing medicine. Challenge it.
Build healthcare technology that gives physicians back
something more valuable than money: attention.
About the Author
Dr. Daniel Cham is a physician and medical consultant
with experience spanning medical technology consulting, healthcare management,
and medical billing. His work focuses on practical insights at the intersection
of healthcare, technology, medical practice, and the operational realities
physicians face every day.
He is also the founder of OnnX, an AI-powered medical
billing technology company focused on helping small and medium-sized medical
practices improve billing operations, reduce unnecessary administrative
friction, and gain greater visibility into their revenue cycle.
Connect with Dr.
Daniel Cham on LinkedIn
Disclaimer
This article is provided for educational and
informational purposes only. It is not legal, medical, coding, compliance,
accounting, tax, or financial advice. Healthcare organizations should evaluate
their individual circumstances and consult appropriately qualified legal,
compliance, coding, financial, clinical, and technology professionals before
making operational or technology decisions.
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