Two premature twins. Two Boston hospitals. One family caught between medical necessity and the desire to keep their daughters together. Their story raises an uncomfortable question about how healthcare systems treat the people who depend on them.
“making a broken workflow faster doesn’t fix the workflow.” — Richard Atkin, CEO of Greenway Health, The New Rules of Leadership in the Era of AI
Healthcare can perform extraordinary medical procedures and still leave families struggling to navigate the system around them. For independent physicians, the same operational question takes another form: are we solving administrative problems, or simply getting better at managing them?
Two babies. Two hospitals. One question healthcare cannot ignore.
Mike and Kelsey Kennedy of Canton, Massachusetts, are facing a situation no parent prepares for.
Their twin daughters, Juliette and Kendall Kennedy, were born at just 24 weeks of pregnancy.
Both babies needed intensive medical care. Kendall was born with spina bifida and underwent surgery at Boston Children’s Hospital. Juliette required heart surgery and received care at Brigham and Women’s Hospital.
The sisters who entered the world together were receiving treatment in separate hospitals.
At home, the Kennedys also have two young children, Callan and Aurora. Their parents must balance the needs of all four children while navigating the uncertainty surrounding their newborn daughters.
In an October 6 report, CBS Boston quoted Mike Kennedy describing the helplessness of watching his daughters surrounded by medical equipment.
“It’s difficult. They’re in a glass enclosure with feeding tubes and breathing tubes.”
For a parent, the hardest part is not necessarily understanding that specialized medical care is necessary. It is knowing that your children need you while being unable to be in two places at once.
The family has expressed gratitude for the doctors and nurses caring for their daughters. Their request to reunite the twins exists alongside the clinical realities of medical stability, specialist needs, and hospital capacity.
This is not a story about blaming clinicians for difficult decisions. Nor does it establish that either hospital has provided inappropriate care.
It is a story about the human experience surrounding medical treatment.
And it raises a question worth asking throughout healthcare:
When a system becomes complicated, who carries the burden of making it work?
For the Kennedy family, the answer is painfully personal.
For a physician running an independent practice, the answer might be a receptionist correcting insurance information, a nurse chasing an authorization, a biller resubmitting a rejected claim, or a physician finishing documentation after the last appointment.
Different circumstances. Different stakes.
But a shared operational question remains: How much unnecessary work are we asking people to absorb because our processes are not working as well as they should?
Healthcare has a strange talent for making hard things possible and simple things difficult
Modern medicine can perform extraordinary procedures.
It can care for babies born extremely prematurely. It can coordinate complex surgeries. It can help patients recover from conditions that once offered little hope.
These achievements deserve recognition.
Yet healthcare professionals and patients still encounter administrative processes that are confusing, repetitive, and unnecessarily difficult to navigate.
A patient completes an intake form, only to provide the same information again.
A physician finishes an encounter, but the documentation still requires additional work.
A billing team submits a claim, receives a rejection, investigates the cause, corrects the record, and submits it again.
A practice manager spends an afternoon figuring out why a task marked complete never produced the expected result.
Some of this work is necessary. Some reflects legitimate clinical, contractual, or regulatory requirements.
But some deserves a more uncomfortable question.
Why are we still doing this?
Not “How can we do it faster?”
Not “Which software can help us manage it?”
Not even “Who can we hire to handle the additional workload?”
First ask why the work exists.
Healthcare sometimes behaves as if every recurring problem deserves another layer of process.
A missing document creates a reminder. The reminder creates a work queue. The work queue needs monitoring. The monitoring creates a dashboard. The dashboard generates another report.
Congratulations. We have successfully built a small administrative civilization around a missing document.
The humor is intentional. The cost is real.
Every additional step consumes attention. Every correction competes with other work. Every unclear handoff creates an opportunity for something to be delayed or forgotten.
The answer is not to eliminate all process. Reliable healthcare needs structure, documentation, oversight, and accountability.
The answer is to distinguish necessary complexity from complexity we have simply learned to tolerate.
A process that requires heroic effort every day may not be a well-designed process. It may be a process that has learned to survive.
That distinction matters enormously for small medical practices, where staff capacity and physician time are limited.
The contrarian truth: Your billing team may not have a billing problem
Here is a thought that challenges conventional revenue-cycle thinking:
Some medical billing problems begin before billing ever starts.
Imagine a patient arrives for an appointment.
An insurance detail is entered incorrectly. Nobody notices.
The physician provides appropriate care. The encounter is completed.
The billing team receives the information and submits the claim.
The payer rejects it because the information does not match its records.
Now the billing team must investigate. Someone checks eligibility. Someone contacts the patient. Someone corrects the record. Someone resubmits the claim. Someone monitors the result.
One small error has created a chain of work.
And the billing team may be blamed for the delay.
This is the operational equivalent of blaming the fire department for being busy while ignoring the faulty wiring.
The analogy is imperfect, but the lesson is important: the person who discovers a problem is not necessarily the person or process that created it.
The original issue may have started during registration, eligibility verification, documentation, authorization, charge capture, coding, or an information handoff.
The billing team often sees the consequences rather than the beginning.
A practice can become exceptionally good at correcting errors without becoming any better at preventing them.
That is why I believe medical billing is partly a data-quality problem, not simply a billing-workflow problem.
A team can improve its downstream processes while leaving the upstream source of recurring errors untouched.
It can get faster at fixing the same mistakes.
It can buy software to manage the additional work.
It can hire more people to keep the process moving.
Or it can investigate why the work keeps returning.
The last option is less glamorous than launching a new technology platform.
It may also be the more valuable place to begin.
The statistics: Administrative burden is not just an inconvenience
Administrative friction is not merely a collection of frustrating anecdotes.
Prior authorization provides a measurable example.
The American Medical Association has documented substantial administrative burdens associated with prior authorization in its physician surveys.
Its survey findings reported in 2026, based on the 2025 survey, included the following:
- 40 prior authorization requests per physician per week, on average.
- Approximately 13 hours of physician and staff time per week devoted to those requests.
- 95% of surveyed physicians reported that prior authorization delays access to necessary care.
- 79% said patients sometimes abandon treatment because of authorization challenges.
- 94% said prior authorization contributes to physician burnout.
These figures reflect survey responses. They are not proof that every authorization is unnecessary or that every delay causes harm. Prior authorization can serve legitimate purposes, and practices must distinguish appropriate clinical review from avoidable administrative friction.
But the reported workload deserves attention.
Thirteen hours is not an abstract number. It represents time that physicians and staff say they spend navigating authorization requirements.
Some of that work requires clinical expertise. Some requires payer communication. Some may involve information that the practice cannot control.
The operational question is how much time is spent on meaningful review and how much is spent correcting incomplete information, chasing responses, duplicating work, or checking the status of requests.
The distinction matters.
The objective is not to eliminate necessary work. It is to stop treating avoidable work as inevitable.
Three expert perspectives that challenge conventional thinking
These perspectives are drawn from published work by established healthcare experts and organizations. They are summaries of their work, not new interviews or endorsements of OnnX.
Expert 1: Richard Atkin — Do not automate yesterday’s mistakes
In his October 7, 2026, article for Greenway Health, CEO Richard Atkin argues that healthcare leaders should not confuse the speed of technology adoption with meaningful progress.
His central point is particularly relevant to medical billing: before automating a process, leaders should examine why it exists, which steps still serve a purpose, and where human judgment is valuable.
Consider a workflow that repeatedly produces incomplete claims.
Automating claim submission might make the process faster. But if the underlying information remains incomplete, the organization may simply produce errors more efficiently.
That is not transformation. It is acceleration.
Practical advice: Before implementing automation, map the workflow, identify recurring failure points, and establish the outcome you want to improve. Then measure whether the technology delivers that improvement.
Expert 2: The American Medical Association — Administrative work affects clinical capacity
The AMA’s prior authorization research documents physicians’ concerns about delays, workload, and the effect of administrative requirements on patient care.
The lesson for independent practices is that administrative requirements should be evaluated not only by whether a task was completed, but also by the time and resources needed to complete it.
A process can be technically compliant while still imposing avoidable duplication.
Practical advice: Track authorization turnaround times, identify recurring payer-specific obstacles, clarify ownership of outstanding requests, and establish escalation procedures.
Where requirements are necessary, make compliance as predictable as possible. Where duplication exists, investigate whether it can be removed.
Expert 3: The Agency for Healthcare Research and Quality — Coordination requires clear information and accountability
The Agency for Healthcare Research and Quality describes care coordination as the deliberate organization of patient-care activities and the sharing of information among the people responsible for care.
This principle also offers a useful way to examine administrative handoffs.
A receptionist, physician, coder, biller, and external billing company may each complete their assigned task. Yet the overall process can still fail if nobody owns the outcome.
Practical advice: For every handoff, define the information required, the next responsible person, what counts as completion, and how completion will be verified.
A message sent is not necessarily a task completed.
A claim submitted is not necessarily a claim resolved.
A checkbox ticked is not necessarily a problem solved.
Five medical billing myths that deserve retirement
Myth 1: More follow-up always means better revenue cycle management
Follow-up is essential when claims are delayed, denied, or unpaid.
But repeated follow-up can also reveal a process that is not working properly.
If staff continually contact payers because documentation is incomplete, claim status is unclear, or information must be corrected repeatedly, more follow-up may treat the symptom rather than the cause.
Better approach: Measure why follow-up is necessary and determine which causes are preventable.
Myth 2: Every denied claim is a billing department failure
The billing team may discover the denial without having caused it.
The original problem could involve registration, eligibility, authorization, documentation, coding, contractual requirements, or payer decisions.
Blaming the final person in the chain is convenient. It is not necessarily accurate.
Better approach: Trace recurring denials to their origin and involve the team responsible for that step.
Myth 3: More software means fewer problems
Software can help with validation, monitoring, reporting, and repetitive tasks.
But it cannot automatically fix unclear responsibilities, unreliable source data, or poorly designed processes.
Automating a flawed workflow can produce the same errors at greater speed.
Better approach: Understand the process before selecting the tool, then measure whether the tool improves accuracy, reliability, and total workload.
Myth 4: Outsourcing makes billing someone else’s problem
An external billing company can provide expertise and capacity.
But outsourcing does not remove the practice’s need to monitor performance, protect patient information, understand financial results, and maintain appropriate oversight.
A contract is not a substitute for accountability.
Better approach: Establish clear reporting standards, service expectations, security requirements, and escalation procedures.
Myth 5: A submitted claim is a completed claim
Submission is a milestone, not the final outcome.
A claim can still be rejected, denied, underpaid, delayed, or incorrectly adjudicated.
Better approach: Monitor the claim through adjudication, payment, reconciliation, and appropriate resolution.
Measure outcomes rather than celebrating activity.
Seven practical steps to reduce administrative waste
You do not need a complete technology overhaul to start improving your revenue cycle.
Begin with one recurring problem that matters.
Step 1: Map what really happens
Choose a process, such as eligibility verification, claim submission, denial management, or payment posting.
Document the actual sequence of events.
Who touches the information? Which systems are involved? Where does the work stop? What causes it to return to an earlier step?
Ask staff where they spend time correcting information, waiting for responses, or following up on tasks that should already be resolved.
Do not map the process as management imagines it. Map it as employees experience it.
Step 2: Establish a baseline
Before changing anything, determine how the process performs today.
Useful measures include:
- First-pass claim acceptance rate.
- Initial denial rate, using a clearly defined denominator.
- Days in accounts receivable.
- Receivables aged beyond 60 or 90 days.
- Time from encounter to claim submission.
- Average denial resolution time.
- Staff hours spent on rework.
- Net collection rate, calculated consistently.
- Outstanding authorization requests.
- Frequency of corrected documentation.
Benchmarks vary by specialty, payer mix, contract terms, and practice size. Avoid comparisons unless the definitions and circumstances are comparable.
Step 3: Identify recurring errors
Review a representative sample of rejected and denied claims.
Classify the causes.
Are problems concentrated in eligibility, documentation, coding, authorization, payer routing, timely filing, or payment discrepancies?
Separate preventable problems from those requiring payer intervention or clinical judgment.
Prioritize by frequency, financial impact, patient consequences, and effort required to fix the issue.
Step 4: Improve information at the source
If inaccurate information enters the system, downstream correction becomes expensive.
Review whether registration captures the necessary information, eligibility is checked at the appropriate time, and missing data can be identified before claim submission.
Use validation rules where appropriate.
For clinical documentation, preserve the physician’s judgment and the integrity of the medical record.
The goal is not more documentation for its own sake. It is accurate, complete information that supports appropriate care and reimbursement.
Step 5: Make handoffs explicit
For each recurring task, establish five things:
- Who owns the next action?
- What information must be transferred?
- What counts as completion?
- How is completion verified?
- When should the issue be escalated?
This is particularly important when multiple departments, external billers, or separate technology systems are involved.
A task should not disappear simply because it has moved to another queue.
Step 6: Automate selectively
Automation may support data validation, routine claim-status monitoring, work queues, reminders, and identification of recurring patterns.
Start with stable, well-defined processes.
Keep human review where clinical interpretation, ambiguous payer requirements, or consequential decisions require judgment.
Test tools against real cases. Monitor errors introduced by the tool as well as time saved.
A successful implementation should reduce total work, not merely move it from one employee to another.
Step 7: Review results monthly
Choose a small set of measures that reflect your goals.
Review what improved, what deteriorated, and what remains unexplained.
Ask staff whether the new process is easier to use. Look for unintended consequences, such as additional data entry or confusing exceptions.
If the change does not improve the outcome, revise it.
Improvement is a continuous process, not a software installation.
The pitfalls: How well-intentioned improvements go wrong
Automating before understanding the cause. A tool may flag missing information without explaining why it is repeatedly absent.
Optimizing one department at the expense of another. A workflow that makes billing easier may create more work for clinicians or front-desk staff.
Measuring activity instead of outcomes. Claims submitted, calls made, and tasks completed reveal workload. They do not necessarily demonstrate payment, accuracy, or resolution.
Ignoring the people who perform the work. Employees often understand exceptions and workarounds that management does not see. Involve them before redesigning the workflow.
Treating every denial as preventable. Some denials reflect contractual disputes, payer decisions, medical-necessity determinations, or factors beyond the practice’s direct control.
Confusing speed with quality. A faster process is not an improvement if it produces inaccurate claims, unreliable records, or additional compliance risks.
The objective is reliable work with less unnecessary effort.
Legal and ethical considerations: Efficiency has boundaries
Medical billing improvements must respect applicable HIPAA privacy and security requirements, accurate documentation, truthful claims, coding rules, payer contracts, and relevant federal and state laws.
Several principles deserve particular attention.
Documentation integrity: Never alter clinical documentation merely to support reimbursement. Corrections and amendments should follow appropriate policies.
Coding accuracy: Automation should support qualified review and established coding rules. Financial targets must never override clinical facts.
Privacy and security: Assess access controls, data handling, retention, safeguards, and contractual obligations before adopting a technology platform. Where applicable, establish appropriate business associate agreements.
Human oversight: Ensure that consequential automated recommendations can be reviewed, especially when they affect claims, appeals, or patient balances.
Vendor accountability: Define responsibilities, audit rights, security requirements, and procedures for incidents and disputes.
Patient communication: Financial processes should not mislead patients or obscure the status of a claim.
Efficiency is not an excuse to cut corners.
The objective is to complete legitimate work accurately, securely, and with less unnecessary effort. Practices should consult qualified legal, coding, and compliance professionals when evaluating specific requirements.
What healthcare founders should learn from this
Healthcare technology founders often begin with a reasonable question:
What task can we automate?
But there is a more revealing question:
Why does this task exist in the first place?
If staff repeatedly correct missing information, perhaps the opportunity is better validation at the point of entry.
If claims repeatedly fail for the same reason, perhaps the opportunity is to prevent the error instead of speeding up resubmission.
If physicians spend hours navigating administrative processes, perhaps the opportunity is to simplify information exchange, clarify responsibility, or remove duplicate work.
Artificial intelligence can help identify patterns, organize information, and support repetitive administrative tasks.
But AI cannot guarantee accurate source data, sound process design, or appropriate human judgment.
A beautifully written summary of inaccurate information is still inaccurate.
An automated workflow that reproduces a flawed process is still flawed.
And a dashboard that shows exactly how much time staff spend correcting errors does not, by itself, prevent the next error.
Good innovation begins with observation.
Talk to physicians. Listen to staff. Examine real workflows. Identify assumptions. Test small changes. Measure whether they work.
Not every problem needs AI. Not every manual step should be removed. Not every clinical process can be standardized without accounting for individual circumstances.
The goal is not to automate everything.
It is to make the right work easier and unnecessary work less common.
Where OnnX fits into this conversation
I am a physician-entrepreneur and founder of OnnX, an AI-powered medical billing SaaS focused on small and medium-sized physician-owned practices.
My interest in this problem comes from a simple observation: many recurring billing problems have roots earlier in the process.
Information captured during registration, the completeness of documentation, the quality of eligibility checks, and the reliability of handoffs can all influence what happens later in the revenue cycle.
OnnX’s direction reflects an upstream perspective.
Rather than treating every denial or correction as an isolated task, I believe practices should investigate the conditions that make those tasks necessary.
That does not mean every problem can be prevented. Payer policies, contractual disagreements, clinical complexity, and external requirements will continue to create work.
It means we should distinguish unavoidable work from work that better processes could reduce.
For independent practices, the potential value is practical: less avoidable rework, better visibility into outstanding issues, more consistent information, and more time for work that requires human expertise.
OnnX is in its validation stage. Learning from physicians and clinic owners is therefore essential.
The aim is to understand which problems matter most, where current approaches fall short, and what measurable improvement would actually look like.
That requires honest conversations, not unsupported promises.
The best starting point is not a sales pitch.
It is a question:
Where does your practice lose the most time fixing problems that should never have happened?
Frequently asked questions
Why does medical billing create so much administrative work?
The revenue cycle depends on information from registration, eligibility verification, clinical documentation, coding, authorization, payer adjudication, and payment reconciliation.
When information is incomplete, inconsistent, or delayed, staff must investigate and correct the resulting problems.
The first step is to identify recurring sources of rework rather than assume every practice has the same issue.
How can a small practice reduce claim denials?
Review a representative sample of denials, classify the causes, and prioritize frequent, preventable errors.
Improve upstream validation, clarify documentation requirements, establish ownership, and monitor whether the same problems return.
Distinguish preventable denials from payer disputes and issues outside the practice’s direct control.
Can AI eliminate the need for medical billers?
No. AI can support repetitive tasks, identify patterns, and help organize information, but qualified professionals remain important for coding, payer rules, exceptions, compliance, and human review.
The appropriate goal is to automate suitable tasks while preserving necessary expertise and accountability.
What should clinic owners measure first?
Start with clearly defined measures such as first-pass claim acceptance, denial rate, days in accounts receivable, rework hours, and the age of unresolved claims.
Choose metrics that reflect your actual problems and establish a baseline before changing the process.
Does outsourcing eliminate billing responsibility?
No. External billing services may provide expertise and capacity, but practices still need appropriate oversight, performance reporting, privacy safeguards, and a clear understanding of financial results.
How does better billing support patient care?
Reliable billing processes can reduce avoidable staff rework and improve financial visibility.
Although better billing does not automatically improve clinical outcomes, reducing unnecessary administrative work can create more capacity for patient communication and other essential activities.
What is the difference between claim submission and claim resolution?
Submission means a claim has been sent to a payer. Resolution means its outcome has been appropriately addressed through payment, correction, appeal, adjustment, or another legitimate disposition.
Submission alone does not establish that the work is finished.
How can practices automate responsibly?
Define the task, establish acceptable error rates, protect patient information, test the system against real cases, and determine when human review is necessary.
Measure unintended consequences as well as benefits.
What should a practice do when the same billing error keeps returning?
Trace the error to its origin, examine the process, assign responsibility, implement a corrective action, and measure whether the error recurs.
Repeated correction without root-cause analysis can consume substantial time without improving reliability.
Can a practice improve billing without replacing its existing systems?
Yes. Begin by mapping one workflow, reviewing denial reports, identifying recurring errors, and testing a focused improvement.
Better responsibilities, data validation, follow-up procedures, and reporting may improve performance without requiring a complete technology replacement.
Final thoughts: Stop rewarding the work that should not exist
The story of Mike and Kelsey Kennedy and their daughters, Juliette and Kendall, reminds us that healthcare is experienced by people navigating uncertainty, difficult decisions, and complicated circumstances.
Their experience is distinct from the administrative challenges faced by independent practices. But it encourages an important question: what unnecessary burdens are people being asked to carry, and what can healthcare organizations reasonably do to reduce them?
For physicians, the lesson is to distinguish necessary administrative work from recurring friction that deserves investigation.
For practice owners, it is to measure outcomes rather than activity and fix root causes rather than repeatedly correct symptoms.
For founders, it is to design technology around real problems rather than assume that another layer of software is always the answer.
Healthcare does not need to make every process simple. It needs to stop making avoidable complexity someone else’s daily responsibility.
Three actions worth taking today
Find the friction. Identify one recurring administrative task that consumes time without reliably moving work toward resolution.
Measure the problem. Establish a baseline, investigate the cause, and test a practical improvement before expanding it.
Protect human attention. Use better processes and appropriate technology to give physicians and staff more room for the work that genuinely requires them.
Continue the conversation
What if the next major improvement in healthcare came not from adding another tool, but from removing an unnecessary step?
Share your perspective: What is the most persistent source of administrative rework in your practice: incomplete information, payer requirements, unclear handoffs, or something else?
Join the discussion: Leave a comment describing one process you would redesign if you could change it tomorrow.
Help other physicians rethink the problem: If this perspective resonates, consider reposting the article to encourage more clinic owners and healthcare leaders to share their experiences.
Knowledge becomes useful when it leads to better questions, practical experiments, and measurable improvement.
If you are exploring ways to make medical billing more predictable or reduce unnecessary administrative work, start by examining your own workflow and identifying what deserves to change first.
P.S. Check the Featured section of my LinkedIn profile for a free resource. No signup is required.
About the author
Dr. Daniel Cham is a physician, medical consultant, and founder of OnnX, an AI-powered medical billing SaaS focused on small and medium-sized physician-owned practices. His work explores the intersection of medical billing, healthcare operations, practice management, and technology, with an emphasis on practical ways to reduce administrative friction and improve operational reliability.
Connect with Dr. Cham on LinkedIn: linkedin.com/in/daniel-cham-md-669036285.
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Disclaimer
This article provides general educational information about healthcare operations and medical billing. It does not constitute legal, medical, coding, reimbursement, or compliance advice. Requirements vary by jurisdiction, payer, practice, and contractual arrangement. Consult qualified professionals for guidance specific to your circumstances.
References and further reading
1. A family navigating the realities of specialized neonatal care. CBS Boston reports on the Kennedy twins’ medical needs, their treatment at separate Boston hospitals, and their parents’ hope of reuniting them.
2. Physician experiences with prior authorization. The American Medical Association summarizes survey findings on administrative workload, treatment delays, and physicians’ reported concerns about patient care.
3. Improving coordination through information and accountability. The Agency for Healthcare Research and Quality provides resources on coordinating care and sharing information among healthcare professionals.
Explore AHRQ’s care coordination resources
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