One Patient Became a Nurse. Why Can’t Healthcare Systems Learn the Same Way?

“Although we are in different systems, none of us compete in quality, safety or equity. There is no competition. We all win together there.” — Jason Mitchell, MD, Executive Vice President and Chief Medical Officer, Geisinger

On February 5, 1984, Megan White entered the world 12 weeks early.

She was born at 29 weeks.

She weighed just 2 pounds, 8 ounces.

Her first home was not a nursery.

It was the neonatal intensive care unit at Ascension St. Joseph Hospital in Milwaukee.

She needed a ventilator.

Her parents had a premature baby.

The medical team had a fragile patient.

And one of the physicians involved in her care was Dr. Stephen Ragatz, a neonatologist who has worked at the hospital for nearly 45 years.

Then something happened that no revenue-cycle dashboard can measure.

Megan grew up.

She survived.

She became a nurse.

And eventually, she returned to the very hospital where her life began.

Not as a patient.

As a NICU nurse.

Today, Megan White has spent 16 years caring for premature infants.

And she works alongside some of the physicians who once cared for her.

Including Dr. Stephen Ragatz.

Think about that.

The 2-pound, 8-ounce baby became the healthcare professional standing on the other side of the incubator.

The patient became the caregiver.

The person who once needed the system became part of the system.

That is an extraordinary human story.

But there is another lesson hiding inside it.

One that has almost nothing to do with neonatology.

And everything to do with how we run medical practices.

Because healthcare has a strange habit.

We talk about patient care as the mission.

Then we build administrative systems that sometimes make delivering that care unnecessarily difficult.

We tell physicians to focus on patients.

Then give them documentation burdens.

We tell nurses to focus on patients.

Then bury them in workflows.

We tell independent practice owners to stay focused on medicine.

Then hand them a revenue cycle that requires the investigative skills of Sherlock Holmes and the patience of a saint.

And when the system breaks?

We call it a billing problem.

I think that’s too simple.

The revenue cycle is part of the clinical infrastructure.

Not because billing is medicine.

It isn’t.

But because sustainable medicine requires sustainable operations.

And sustainable operations depend on information.

That is where Megan White’s story unexpectedly connects to medical billing.

The uncomfortable question

Here is my question for physicians and clinic owners:

What if your billing problem isn’t really a billing problem?

What if it started much earlier?

At registration.

At eligibility verification.

At authorization.

At documentation.

At coding.

At the handoff between clinical and administrative teams.

What if the denial you are working today was created three weeks ago?

Or three months ago?

What if your biller is not failing?

What if you are asking the biller to repair a problem the system created upstream?

This is where I think healthcare needs a different conversation.

We have become very good at fixing problems after they become claims.

We need to become much better at preventing them before they become claims.

The great healthcare repair shop

Consider the typical revenue cycle.

A patient arrives.

The front desk verifies insurance.

The physician sees the patient.

The physician documents the encounter.

Someone codes it.

Someone submits the claim.

The payer processes it.

Then, perhaps, the fax machine lights up with bad news.

Denied.

Pending.

Incorrect.

Missing information.

Authorization required.

Modifier issue.

Medical necessity question.

Duplicate.

Timely filing.

Wrong payer.

Wrong patient.

Wrong something.

Now the practice starts repairing.

The biller investigates.

The coder reviews.

The physician gets a query.

The payer gets called.

An appeal is submitted.

A corrected claim goes out.

Everyone celebrates when the payment finally arrives.

And then we do it again tomorrow.

This is not necessarily a people problem.

It is often a system-design problem.

We have built an enormous healthcare repair shop.

And then we congratulate ourselves for becoming very efficient at repairing things.

That’s a little like designing a leaky roof and then celebrating how quickly you mop the floor.

Megan White gives us a different way to think

Megan’s story is about continuity.

Her care did not end when she left the NICU.

The experience became part of her life.

Eventually, it influenced her career.

She came back and became part of the next generation of care.

Healthcare leaders should think about operations the same way.

An encounter should not be an isolated event.

It should create a useful information trail.

Clinical intent → documentation → coding → claim → payment → learning → better future workflow.

That last word matters.

Learning.

Too many revenue cycles stop at payment.

The claim gets paid.

The file gets closed.

The team moves on.

But the organization learned almost nothing.

Then the same denial appears next Tuesday.

And Wednesday.

And Friday.

At some point, that stops being bad luck.

It becomes a process.

The biggest myth in medical billing

Here is one of my favorite myths:

“We just need a better biller.”

Sometimes you do.

Great billing professionals are incredibly valuable.

But even the best biller has limits.

A biller cannot reliably recover clinical intent that was never captured.

A biller cannot control a payer’s policy.

A biller cannot fix a confusing EHR workflow.

A biller cannot permanently solve a recurring documentation problem by correcting the same claim 200 times.

And a biller certainly shouldn’t need to become the institutional memory of every payer rule in America.

That isn’t a workflow.

That’s survival.

The second myth

“We need more staff.”

Maybe.

But before adding another person, ask:

How much of our staff’s workload exists because our process creates avoidable work?

That question can be uncomfortable.

Suppose five employees spend several hours every week correcting the same category of errors.

Hiring another employee may increase capacity.

It does not necessarily eliminate the error.

You have increased the size of the bucket.

You haven’t fixed the hole.

The third myth

“AI will fix medical billing.”

This one is particularly fashionable.

And particularly dangerous when oversimplified.

AI can absolutely help.

It can identify patterns.

Classify information.

Flag inconsistencies.

Assist with coding workflows.

Surface anomalies.

Summarize documentation.

Predict potential problems.

Prioritize work.

But AI is not magic dust.

If the underlying information is incomplete, inconsistent, or poorly structured, AI doesn’t automatically transform it into truth.

Better intelligence requires better information.

That is why I believe the more important question is not:

“Where can we add AI?”

It is:

“Where can we improve the information before AI ever touches it?”

The real problem may be upstream

This is the thesis behind what I am building with OnnX.

Healthcare billing is often treated as a downstream optimization problem.

I see it differently.

It is frequently an upstream data-quality problem.

Think about the chain:

Patient

↓

Encounter

↓

Clinical intent

↓

Documentation

↓

Coding

↓

Claim

↓

Payer

↓

Payment

Every arrow is a potential failure point.

The farther downstream you discover the problem, the more expensive it can become to fix.

That’s why I am interested in moving intelligence upstream.

Not replacing physicians.

Not replacing clinical judgment.

Not creating another dashboard nobody opens.

But helping practices identify potential problems earlier.

Why this matters right now

The timing is important.

This week, MGMA reported that fewer than one in 10 medical practices saw faster prior-authorization turnaround times in 2026, while 44% of medical group leaders reported that payer turnaround had become slower.

The AMA has also documented the continuing administrative burden of prior authorization on physicians and their teams.

And the policy environment isn’t exactly getting boring.

CMS continues to update payment and coding policies.

The proposed 2027 Medicare Physician Fee Schedule has generated concern among physician organizations about payment changes, including proposed treatment of certain same-day E/M services.

There are also ongoing debates about coding structures and how physicians are paid.

Meanwhile, practices still have patients waiting in examination rooms.

The contradiction is obvious.

The clinical environment changes quickly. The administrative infrastructure often doesn’t.

The statistic that should bother practice owners

The AMA has reported that physicians and their staff spend substantial time dealing with prior authorization, with physicians reporting an average of 40 prior authorizations per week and roughly 13 hours of physician and staff time per week devoted to the process.

Even more striking:

94% of surveyed physicians said prior authorization contributes to burnout.

95% said it delays necessary care.

79% reported that patients sometimes abandon treatment because of authorization problems.

Those aren’t just administrative statistics.

They’re human statistics.

Every hour consumed by avoidable administrative work is an hour that cannot be spent doing something else.

Seeing another patient.

Calling a patient.

Reviewing a complex case.

Training a staff member.

Going home on time.

Having dinner with your family.

Healthcare loves to measure dollars.

We should also measure attention.

Because attention is finite.

Expert perspective: Dr. Jill Jin

Jill Jin, MD, MPH, has contributed to AMA education around outpatient documentation and coding.

The lesson isn’t “write more.”

It is almost the opposite.

Write what matters.

Documentation should tell the clinical story clearly enough to support the service provided.

That means capturing the reasoning that matters.

What problem was addressed?

What information was considered?

What decisions were made?

What risks mattered?

What was the plan?

The objective isn’t to produce the longest note in the building.

Nobody wins a Pulitzer Prize for a 14-page progress note.

Longer is not automatically better.

Clearer is better.

Expert perspective: Dr. Jeannine Engel

Jeannine Engel, MD, MACP, has also contributed to AMA education on documentation and coding.

The practical lesson for physicians is to understand what actually drives coding rather than relying on myths.

A physician should not document unnecessary material simply because someone once said:

“More words equals more reimbursement.”

That’s not a sound strategy.

The better strategy is:

accurate clinical reasoning + appropriate documentation + correct coding.

Simple.

But healthcare has a talent for making simple things complicated.

Expert perspective: Dr. Kevin D. Hopkins

Kevin D. Hopkins, MD, a family medicine physician and physician leader involved in AMA documentation and coding education, reinforces the importance of making documentation and coding workflows understandable to physicians.

That matters because technology should serve the clinical workflow.

Not the other way around.

If a system forces physicians to think like coders while they’re trying to think like physicians, something has gone wrong.

The software should carry more of the administrative burden.

The clinician should retain the clinical judgment.

Here’s my contrarian take

I think healthcare has confused documentation volume with information quality.

And it has confused billing activity with revenue-cycle performance.

Those aren’t the same thing.

A practice can have hundreds of employees touching claims and still have a weak revenue cycle.

A practice can have sophisticated software and still have poor data.

A practice can submit thousands of claims and still leak revenue.

And a practice can have a high collection rate while quietly accumulating operational problems.

Activity is not performance.

Work is not necessarily progress.

That distinction is crucial.

What should physicians actually measure?

Forget the giant dashboard with 47 metrics.

Start with the basics.

Clean-claim rate

How many claims are accepted without avoidable corrections?

Denial rate

How frequently are claims denied?

Denial dollars

How much money is represented by those denials?

Days in A/R

How long does earned revenue remain outstanding?

Underpayment rate

Are payments consistent with contractual expectations?

Correction volume

How many claims require human intervention?

Root-cause concentration

Are a few recurring problems creating most of the leakage?

That final metric is particularly powerful.

Because concentration creates leverage.

If three problems create 60% of your avoidable administrative work, you don’t need a hundred projects.

You need three good projects.

A simple experiment for your practice

Try this next week.

Take your last 100 denied claims.

Don’t appeal them yet.

First categorize them.

Use buckets such as:

Eligibility

Authorization

Documentation

Coding

Modifier

Medical necessity

Duplicate

Timely filing

Payer processing

Other

Then ask:

Which three categories create the most financial damage?

Now ask the more important question:

Where did those problems begin?

Not where they were discovered.

Where did they begin?

That’s your leverage point.

A practical 30-day revenue-cycle reset

Days 1–7: Stop guessing

Pull 90 days of claims and payment data.

Identify:

Top payers.

Top denial reasons.

Top dollar losses.

A/R aging.

Correction volume.

Underpayments.

Do not start by buying software.

Start by understanding the problem.

Days 8–14: Find the root

Choose your top three problems.

For each one, trace the workflow backward.

Where did the information originate?

Who entered it?

Who changed it?

Who interpreted it?

Where was the first opportunity to catch the problem?

You are looking for the first failure, not the last person who touched the claim.

Days 15–21: Fix one workflow

Pick one.

Maybe eligibility.

Maybe authorization.

Maybe documentation.

Maybe coding.

Maybe claim validation.

Don’t redesign your entire practice.

Healthcare projects have a funny habit of becoming dissertations.

Keep it small.

Days 22–30: Measure again

Did the denial rate change?

Did correction volume fall?

Did staff time improve?

Did A/R improve?

Did physicians experience less friction?

If yes, repeat.

If no, learn.

Then adjust.

The physician’s role

Physicians should not become billing experts.

But physicians should understand the financial consequences of clinical information.

That distinction matters.

A physician doesn’t need to memorize every payer rule.

But they should understand:

Why documentation matters.

Why medical necessity matters.

Why coding accuracy matters.

Why incomplete information creates downstream work.

Why payer variation matters.

And why a recurring billing problem may indicate a workflow problem rather than an individual employee problem.

That is enough to make better decisions.

The clinic owner’s role

Clinic owners have a different responsibility.

They need visibility.

You should know:

Where revenue is leaking.

Why it is leaking.

Who is spending time fixing it.

How often it happens.

Whether it is preventable.

And perhaps most importantly:

Whether the problem is getting better.

If your only financial metric is:

“Did we collect enough this month?”

you’re looking in the rearview mirror.

The technology founder’s responsibility

Healthcare founders have their own trap.

We love features.

Dashboards.

Integrations.

AI.

Automation.

Predictive analytics.

Agents.

APIs.

Beautiful interfaces.

But physicians don’t wake up thinking:

“I hope someone gives me another dashboard today.”

They wake up thinking:

“I have 24 patients.”

Technology has to respect that reality.

The best healthcare technology often does something surprisingly unglamorous:

It removes work.

That should be the benchmark.

Not:

“How sophisticated is the technology?”

But:

“How much unnecessary friction disappeared?”

What OnnX is trying to change

OnnX is being built around a simple idea:

Make the revenue cycle more predictable by improving the information and workflow upstream.

The goal isn’t to make physicians think about billing more.

It’s to make them think about it less.

That means looking for opportunities to:

identify preventable problems earlier

reduce repetitive billing work

surface payer patterns

improve data consistency

connect clinical information with reimbursement workflows

reduce avoidable claim friction

And ultimately:

help independent practices keep more of the revenue they have legitimately earned.

No magic.

No promise that every denial disappears.

No suggestion that AI replaces judgment.

Just better infrastructure.

What about the patient?

This is where the Megan White story comes back.

A medical practice is not a factory.

The output isn’t claims.

The output is care.

Claims are part of the machinery that finances that care.

That distinction matters.

If billing consumes excessive staff time, someone pays.

If physicians spend hours fixing documentation issues, someone pays.

If claims sit unresolved for months, someone pays.

If independent practices become financially unsustainable, communities pay.

And eventually patients may pay through reduced access, fewer services, longer waits, or consolidation.

That’s why revenue-cycle improvement isn’t merely about making owners richer.

It can be about protecting access to independent medical care.

The human lesson

Megan White’s story is extraordinary because it closes a circle.

A baby entered a hospital.

A team cared for her.

She survived.

She grew.

She chose healthcare.

She returned.

And now she helps other families.

Dr. Stephen Ragatz once saw Megan as a premature newborn.

Today, he sees her as a colleague.

That is what healthcare can look like at its best.

Not a transaction.

A continuum.

And that is how I think we should approach healthcare operations.

Not as isolated events.

But as connected systems.

Encounter → information → decision → documentation → reimbursement → learning → better care.

When the chain works, everybody benefits.

When it doesn’t, everybody feels the friction.

The bigger opportunity

There is a bigger healthcare question hiding underneath all of this.

We spend enormous amounts of money trying to improve medicine.

But how much attention do we give to the systems that allow physicians to practice medicine sustainably?

We fund new therapies.

New devices.

New diagnostics.

New AI models.

New digital platforms.

All valuable.

But sometimes the innovation opportunity is less glamorous.

Fix the handoff.

Fix the data.

Fix the workflow.

Fix the feedback loop.

Remove the unnecessary step.

Make the system easier for the human being actually using it.

That’s innovation too.

Maybe especially so.

Ethical considerations

Revenue optimization needs a boundary.

That boundary is truth.

The objective should never be:

“How do we make this encounter pay more?”

The objective should be:

“How do we accurately represent the care that actually occurred?”

Those are very different questions.

Technology should never encourage unsupported coding.

Physicians should never alter clinical decisions for reimbursement.

Documentation should not be manufactured after the fact.

AI recommendations should remain subject to appropriate human oversight.

And practices need appropriate safeguards around patient information, privacy, security, and compliance.

Automation does not eliminate responsibility.

It increases the importance of knowing who is accountable.

Legal and compliance considerations

Medical billing operates inside a complex regulatory environment.

Depending on the practice and payer mix, considerations may include:

HIPAA and privacy requirements

coding compliance

medical necessity

payer contracts

False Claims Act risk

fraud and abuse laws

overpayment obligations

documentation requirements

audit readiness

AI governance

vendor contracts and business associate agreements

The details matter.

A technology platform should not be viewed as a compliance shield.

Physicians and organizations remain responsible for appropriate oversight.

The safest approach is not to avoid technology.

It is to implement technology with clear governance, auditability, appropriate access controls, human oversight, and documented processes.

Tools and resources

Physicians don’t need to build a NASA mission-control center.

Start with a few useful tools.

Revenue-cycle dashboard

Track the metrics that actually affect your practice.

Denial log

Record the reason, payer, code, dollar amount, root cause, and resolution.

Payer matrix

Maintain a current reference for important payer-specific requirements.

Documentation education

Give physicians short, practical education rather than giant coding manuals.

CMS resources

Use authoritative CMS payment and coding resources when evaluating Medicare requirements and payment policies. CMS maintains its Physician Fee Schedule tools and payment information online.

AMA resources

The AMA maintains resources for private practices, including guidance on improving revenue-cycle processes.

Weekly review

Thirty minutes.

Three questions:

What went wrong?

Why?

How do we stop it happening again?

The future of medical billing

I don’t think the future is humans versus machines.

That’s the wrong argument.

The future is probably:

better information + automation + human judgment.

AI can help analyze patterns.

Automation can handle repetitive work.

Software can surface exceptions.

But physicians still make clinical decisions.

People still oversee important workflows.

Patients still need empathy.

And someone still needs to ask:

“Does this make sense?”

That question may be the most valuable piece of technology in healthcare.

It is called judgment.

A future worth building

Imagine a practice where:

A potential eligibility problem is identified before the visit.

A documentation gap is surfaced before claim submission.

A recurring payer pattern is detected automatically.

A likely claim problem is flagged before it becomes a denial.

A staff member spends five minutes reviewing an exception instead of an hour repairing it.

A physician receives useful feedback rather than another generic warning.

The system learns from previous outcomes.

And the owner can see where revenue is being lost without opening 11 different spreadsheets.

That is not science fiction.

Pieces of that future already exist.

The opportunity is connecting them intelligently.

What I believe

I believe healthcare has spent too much time asking:

“How do we work harder?”

We should ask:

“Why does this work exist?”

I believe physicians should spend more time practicing medicine and less time translating medicine into administrative language.

I believe independent practices deserve technology designed for their realities, not technology designed around enterprise assumptions.

I believe billing should become less mysterious.

I believe AI should reduce administrative friction rather than create another layer of it.

And I believe the best healthcare technology will eventually become almost invisible.

If it works, you don’t think about it.

You simply notice that your day is easier.

And that’s why Megan White’s story matters

Megan White entered Ascension St. Joseph Hospital as a premature baby.

She returned decades later as a nurse.

Dr. Stephen Ragatz saw both versions of her.

The fragile newborn.

The experienced professional.

Same hospital.

Different chapter.

That is the beautiful thing about healthcare.

We rarely know where a patient’s story will go.

A patient today may become a nurse tomorrow.

A frightened parent may become an advocate.

A survivor may become a researcher.

A former patient may become a physician.

The encounter is only one chapter.

The patient is the whole story.

And our systems should be designed accordingly.

That includes our revenue cycle.

Because if the administrative infrastructure becomes so complicated that physicians spend more time fighting the system than caring for people, we’ve lost sight of the point.

The goal isn’t more claims.

More codes.

More dashboards.

More staff.

More software.

The goal is better healthcare.

And sometimes, the best way to improve healthcare is to remove the friction that keeps good people from doing their best work.

Final Thoughts: Stop repairing what you could prevent

Maybe the biggest mistake in revenue-cycle management is that we have become comfortable with repair.

We accept denials.

We accept corrections.

We accept appeals.

We accept payer calls.

We accept administrative waste.

We accept that physicians will spend evenings finishing documentation.

We accept that staff will chase money that has already been earned.

We call it “the way healthcare works.”

I’m not convinced.

Healthcare is complicated. That doesn’t mean healthcare has to be unnecessarily complicated.

Megan White’s story reminds us that healthcare is ultimately about continuity.

One generation cares for the next.

One patient becomes a caregiver.

One clinical encounter can influence an entire life.

Our operational systems should support that continuity rather than compete with it.

The future of medical billing is not more bureaucracy.

It is better information.

It is smarter workflows.

It is fewer preventable problems.

And most importantly:

It is giving physicians back the attention they never should have had to surrender in the first place.

Get Involved: Your Practice Has a Story Too

Here’s the provocative question I’d like to leave you with:

What is the most ridiculous recurring billing problem your practice has learned to tolerate because everyone assumes “that’s just healthcare”?

Maybe it’s a denial.

Maybe it’s an authorization.

Maybe it’s a payer rule.

Maybe it’s a documentation problem.

Maybe it’s a spreadsheet someone built five years ago that has somehow become mission-critical.

Tell me about it.

Leave a comment.

Your experience may help another physician recognize a problem they’ve been quietly tolerating too.

And if this perspective resonates, share or repost this article with another physician, practice owner, medical director, or healthcare operator.

The goal isn’t to complain about the system.

It is to understand it well enough to improve it.

Ask the uncomfortable question.

Share what you’ve learned.

Help build a healthcare system where technology removes friction instead of creating more of it.

Continue the Conversation

Healthcare improves when people in the field share what actually works.

I write about medicine, medical billing, healthcare operations, medical technology, entrepreneurship, and practical innovation from the perspective of a physician and healthcare entrepreneur.

For additional perspectives and practical strategies, explore:

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Knowledge creates leverage. The next improvement in your practice may begin with one better question.

Free Resource

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Visit the Featured section of my LinkedIn profile for a free resource. No signup required.

Use it to explore practical approaches to revenue-cycle management, medical billing, documentation, and reducing administrative friction in independent practice.

And if this article made you rethink billing even a little:

Consider reposting it.

A physician somewhere is probably dealing with the same problem.

Your repost might be the thing that makes them question it.

About the Author

Dr. Daniel Cham is a physician, medical consultant, healthcare entrepreneur, and founder of OnnX, an AI-powered medical billing SaaS focused on helping small and medium-sized medical practices reduce administrative friction and improve revenue-cycle performance.

His work sits at the intersection of clinical medicine, healthcare management, medical technology, revenue-cycle strategy, and practice operations.

Dr. Cham focuses on practical solutions that help physicians and healthcare organizations navigate increasingly complex administrative environments while keeping the focus where it belongs: patient care.

Connect with Dr. Daniel Cham on LinkedIn

Disclaimer

This article is intended solely for general educational and informational purposes. It does not constitute medical, legal, coding, compliance, financial, or reimbursement advice. Healthcare regulations, payer policies, contracts, and coding requirements can vary by situation and change over time. Readers should consult appropriately qualified professionals for guidance regarding their particular circumstances.

Three Current References

Megan White’s remarkable journey from a 29-week, 2-pound-8-ounce premature infant to a NICU nurse at the same Milwaukee hospital provides the human story at the center of this article.
Read Megan White’s story

MGMA’s latest data illustrates the continuing administrative burden surrounding prior authorization and the difficulty practices are having obtaining faster payer responses.

Read MGMA’s Latest Data

Recent CMS payment and coding developments demonstrate why physician practices need adaptable revenue-cycle workflows rather than static processes.
Review CMS Physician Fee Schedule resources

Final takeaway: Megan White’s story isn’t really about a premature baby who became a nurse. It is about what happens when healthcare succeeds so completely that the patient eventually becomes part of the next generation of care.

That’s the standard we should want from every part of healthcare—including the systems that finance it.

Don’t just work the denial. Find the reason it exists.

Don’t just add another tool. Remove a layer of friction.

Don’t just optimize the claim. Build a practice where fewer claims need rescuing.

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