The One Sentence Costing Your Practice Six Figures

The most expensive sentence in your practice is ‘someone else handles that.’

I do not mean that every physician should personally submit claims, every coder should manage payer contracts, or every biller should redesign the EHR. Delegation is necessary. Abdication is expensive.

I returned last month from the National Medical Association Annual Meeting in Puerto Rico, where I was elected Secretary of the NMA Physicians Executive Section. The conversations in that room centered on innovation, the challenges facing hospital groups and solo practices, leadership, emerging technology, policy, and physician well-being.

I came home thinking about how often I see the same issue in my consulting work. My practice spans coding, billing, clinical documentation improvement, audit defense, compliance, and artificial intelligence implementation: not just coding. Whether I am conducting a coding audit, reviewing a billing operation, leading a CDI engagement, preparing a practice for an audit defense response, or helping a team govern an AI tool, the pattern is remarkably consistent.

A decision reaches a handoff point. The person closest to the decision assumes somebody else owns it. The next person assumes the first person checked it. The claim moves forward anyway.

My professionally contrarian position is this: most practices do not have an information problem first. They have an ownership problem.

This is not a physician problem, a coder problem, or a biller problem. It is a structural problem in how practices assign accountability. Every role in the practice quietly hands off decisions that belong to them. Every role assumes someone else caught it. And every practice pays for it.

What I See Across Practices

In practice after practice, when I do a chart audit, sit in on a billing review, or lead an audit defense engagement, I see the same handoff points where accountability disappears.

The denial rate begins to creep upward, but nobody can explain whether the cause is documentation, eligibility, authorization, bundling, medical necessity, payer policy, or a combination of several problems. Unspecified codes start appearing more frequently, even though the clinical record contains enough information to support greater specificity. E/M visits are downcoded because the practice has decided that conservative coding is safer than asking whether the documentation actually supports the work performed.

Then there is the appeal backlog. It belongs to everyone in theory and no one in practice. The biller sends the issue to the coder. The coder sends it back to the physician. The physician is told the payer made the decision. Meanwhile, the claim ages.

I see AI tools added to workflows without a named person responsible for validating their output. An AI scribe generates a polished note, so everyone assumes the documentation is complete. A coding tool recommends a code, so everyone assumes the logic is compliant. A claims tool flags some denials, so everyone assumes the unflagged claims are safe.

That is not governance. That is a faster version of hope.

The MGMA Stat report, “Detecting and fixing leaks across the revenue cycle,” published January 7, 2026, identified denials and appeals as the largest reported revenue-cycle leak among respondents.

48% of reported revenue leakage comes from denials and appeals.

Undercoded E/M visits, repeated across a physician panel, can cost a practice 3–8% of annual revenue. That is not a rounding error. It is a full staff position that could have been hired — or a losing year in a good market.

That figure does not mean every denial is preventable, and it does not tell us that one person caused the leakage. It tells us that practices need to stop treating denials as isolated administrative events. A denial is often the final visible symptom of an earlier ownership failure. The missing modifier, incomplete medical-necessity statement, authorization gap, or unreviewed payer change began upstream.

You can read the MGMA Stat report here. You can also review the operational questions raised by AI in revenue cycle: Who owns the recommendation? Who validates it? Who measures whether it improved the claim?

The delegation problem is not a coding problem, a billing problem, or an AI problem. It is a leadership problem. And it shows up in every role.

The Five Roles and What Each One Delegates

Physicians: Documentation

In my consulting work, I see physicians relying too heavily on EHR templates to guide their documentation. Documentation should reflect the depth of clinical judgment, but templates often simplify it, missing the complexity and nuance that need to be captured for accurate coding.

The cost is not merely an untidy note. It can be undercoded MDM, insufficient time documentation, and missed complexity capture. A template can organize documentation, but it cannot take clinical responsibility for the reasoning behind the encounter. That remains the physician’s work.

Coders: Specificity

Coders own the translation of clinical documentation into accurate, compliant codes. Too often, they delegate specificity back to the physician: “I coded what the note said.” Sometimes that is exactly right. Sometimes it is the end of a conversation that should have started.

The cost includes unspecified codes when specificity was clinically available, HCC capture failure in Medicare Advantage panels, and undercoded chronic disease. Strong coders do not invent detail. They identify where the record supports detail, where a query is appropriate, and where the documentation truly does not support a more specific code. My work on ICD-10 coding accuracy begins with that distinction.

Billers: Denial Patterns

Billers own the movement of claims through the revenue cycle, but many delegate denial root causes to “the coder.” The biller resubmits the claim, sends an appeal, or places the account back in a queue without asking what the pattern is trying to reveal.

The cost is a rework loop instead of prevention. Accounts receivable ages. Staff members spend their days repeating corrections that do not change the upstream process. A denial is not resolved simply because it was touched. The team must know whether the cause relates to documentation, coding, NCCI bundling rules, modifier usage rules, payer policy, or workflow design.

Practice Managers: Revenue Integrity

Practice managers own visibility. They do not need to become coders or billers, but they do need to know what is happening on the practice’s claims. Instead, many delegate revenue integrity to a vendor and accept a monthly report without testing the assumptions behind it.

The cost is no visibility into what is actually happening in the practice’s own claims and no leverage to challenge a vendor’s conclusions. A report that says “clean claims are improving” is not enough if the practice is losing revenue through conservative coding, delayed charge capture, or unresolved underpayments. Management requires questions, not just dashboards.

Physician Owners: The Revenue Cycle

Physician owners may delegate the whole revenue cycle to “the billing company.” They never ask to see the downcode rate, the denial pattern, or the payer scorecard. They assume outsourcing the work means outsourcing the risk.

This is the one most physician owners have never considered: a billing company may be downcoding to protect itself from an audit that may never have happened to the practice. That is not an accusation against every vendor. It is a reason to examine incentives. A vendor may be trying to reduce its perceived compliance exposure, but the practice may be paying for that caution through lost revenue and incomplete performance data.

Most people get this wrong by confusing activity with accountability. A billing company can process claims. A physician owner still owns the financial and compliance outcome.

If your practice is preparing for CPT 2027 is coming, this is exactly the kind of cross-role accountability that will matter. The maternity restructure will not be implemented successfully by one department working in isolation.

For a live, role-specific conversation about how AI is changing the work of coders, billers, and practice managers, you can reserve your seat at The Indispensable Tour in Dallas on October 3, 2026. Early-bird registration is $347 through August 28.

Why AI Makes This Worse

AI does not create the delegation problem. It accelerates it.

Physicians assume the AI scribe documented correctly. Coders assume the AI tool checked NCCI. Billers assume the system flagged the denial risk. Practice managers assume the platform is protecting the practice. Physician owners assume the vendor’s AI solved the problem.

Each assumption moves accountability farther away from the person who should be validating the decision.

If you did not own decisions when humans were making them, you will not own them when AI is making them. AI does not fix the delegation problem. It hides it.

Through my DocsDoc thought leadership on AI in clinical documentation and my role as Secretary of the NMA Physicians Executive Section — the body where physician leaders are working through AI, algorithmic bias, and health equity in healthcare operations — I've seen firsthand how AI, when implemented without proper oversight, can amplify the delegation problem rather than solve it. The technology is powerful, but without governance, it can lead to costly errors.

I go deeper on this in my book, AI-Driven Clinical Documentation: Standardization Strategies for Healthcare Leaders — available now on Amazon Kindle ($9.99) and in paperback ($29.99). It is the framework I built for the practices I consult with — governance-first, physician-led, and designed to keep human judgment at the center of every AI-assisted decision.

AI can support documentation, coding, billing, and compliance. It cannot be the accountable owner of a claim.

The Fix: Ownership Mapping

Every claim needs a named owner at every step. Every function needs one accountable person. Every AI tool needs a human validator.

An ownership map is a simple document that states who owns the decision, who reviews the work, and who is accountable for the outcome. It does not need to be complicated, expensive, or buried in a policy manual.

Here's what an ownership map looks like at its simplest: Claim submitted → Owner: [named coder]. Denial received → Owner: [named biller]. Pattern review → Owner: [named practice manager]. AI tool validation → Owner: [named physician executive]. Every function has a name.

For example:

E/M coding: The coder owns code selection; the physician owns clinical documentation; the revenue-cycle manager reviews downcode and denial trends monthly; the AI output requires human validation before submission.

That is enough to begin. On Monday morning, choose one claim type, map its handoffs, name the owners, and identify the point where decisions currently disappear.

If you need a broader review, DSK provides physician consultant and audit defense services across coding, billing, CDI, compliance, audit defense, and AI implementation. The goal is not to create more meetings. The goal is to make accountability visible.

The Rule

If you cannot name the person accountable for the coding on a specific claim, that claim does not have an owner. Unowned claims leak money. Unowned decisions get inherited by whoever shows up next — including AI. Ownership is not a workflow question. It is a leadership question.

The Conversation Continues

This is the exact conversation I am having with physician executives, coders, and billers at upcoming events and through coaching: not whether your practice should delegate, but whether your practice knows what it has delegated and who remains accountable.

The CPT 2027 Maternity Webinar is September 16, 2026, and costs $97. In 90 minutes, we will connect documentation, coding, billing, and audit defense across the roles that must implement the changes together.

For physicians moving into broader leadership responsibility, the physician executive coaching program provides a place to build operational clarity and strategic confidence. You can also use the Compliance Plan Toolkit, available for $97, to begin organizing your practice’s compliance responsibilities.

Register for the CPT 2027 Maternity Webinar, name your owners, and stop letting important decisions disappear into the sentence “someone else handles that.”

Schedule a confidential consultation when your practice is ready to map accountability across the revenue cycle.

Dr. Dreama Sloan-Kelly, MD, CCS, CPC
CEO/President, Dr. Sloan-Kelly Consulting LLC