Articles

Improving Billing and Collections in a High-Volume Pediatric Surgery Practice: Denials-Based Approach.[1] Ryan ML et al., J Am Coll Surg. 2023 Apr 1;236(4):630-635. Epub 2023 Jan 12. PMID: 36728227.

Academic pediatric surgeons normally receive minimal training in medical coding and billing yet bear responsibility for accurate documentation and reimbursement. Inadequate coding leads to insurance denials, lost revenue, and increased administrative burden. Appendicitis, the most common pediatric surgical diagnosis, has high litigation rates and frequent billing challenges when documentation or coding lacks specificity. Despite this, many practices underutilize denial data to guide improvements. Laparoscopic appendectomy, the most performed pediatric surgical procedure, has been identified as a major contributor to financial losses due to denials.

This study is the first to systematically analyze denial data in a high-volume academic pediatric surgery practice to identify and address revenue loss. Denials for laparoscopic appendectomy (CPT 44970, 823 claims) represented 12.8% of denied charges ($1.41 million). The authors found that 93.3% of denials issued were associated with nonspecific ICD-10 codes, and 80.7% of these were deemed preventable with improved documentation or timely filing, representing an estimated $1.06 million dollars in recoverable revenue. Based on their denial data, the authors outline a practice remediation strategy based on refining documentation templates and improving ICD-10 code specificity to significantly reduce denials and enhance collections. It proposes a scalable, data-driven approach to optimize billing practices and suggests that similar strategies could be applied to other high-impact procedures.

Exploring Trust and Engagement: A Qualitative Evaluation of the Relationship Between Clinicians and Healthcare Leaders at Academic Medical Centers.[2] Keller EJ et al., J Healthc Leadersh. 2025 Feb 27;17:75-83. PMID: 40046788.

Dysfunctional relationships between clinicians and healthcare leaders are associated with lower clinician engagement, decreased job satisfaction, higher burnout, and increased turnover. While clinician-leaders are often viewed as capable of bridging the cultural divide between clinical and administrative roles, they may also experience isolation and lack full acceptance by either group. Organizational culture and leadership style significantly influence how trust and collaboration evolve within healthcare institutions.

This study explores how trust, engagement, and cultural dynamics vary across organizational, departmental, and practice levels at academic medical centers. It reveals that well-intentioned but poorly targeted leadership interventions can worsen disconnects between clinicians and administrators. The research emphasizes that transparency, humility, and shared decision-making are foundational to building trust, but even these principles may be interpreted differently across groups. Importantly, it highlights that clinicians often derive identity from their profession rather than their organizational role, making them less motivated by traditional leadership hierarchies. Strategies that ignore autonomy and professional values are therefore less likely to succeed.

Transforming the Healthcare Revenue Cycle with Artificial Intelligence in the USA. [3] Adeleke O et al., International Journal of Multidisciplinary Research and Growth Evaluation. 2024;5(3):1069-1083.

In the contemporary landscape of healthcare revenue cycle management (RCM), it is widely recognized that traditional, manual processes are plagued by inefficiencies such as administrative errors, high operational costs, claim denials, and delayed reimbursements, which collectively hinder financial performance and patient experience. Current literature shows Artificial Intelligence (AI) as a transformative solution. Technologies like machine learning (ML), natural language processing (NLP), robotic process automation (RPA), and predictive analytics are used to predict denials, identify billing irregularities, optimize coding, improve communication with patients, automate tasks while reducing human error and administrative burden, and forecast payment patterns. Integrating these AI tools with Electronic Health Records (EHRs) improves data analysis, compliance, and patient financial experiences

This article presents a thorough framework for AI adoption in the U.S. healthcare RCM, outlining the current situation, assessing best practices, and projecting future trends. Through a multi-method qualitative research design, including a comprehensive literature review and expert interviews, the study develops a validated understanding of AI applications across the entire revenue cycle. It specifically demonstrates how AI-driven solutions can automate repetitive operations, identify claims irregularities, and predict reimbursement patterns. The study highlights quantifiable advancements, such as a potential reduction in administrative costs by up to 30%, improved revenue capture, and a significant decrease in claim denials and faster payment cycles. Furthermore, it underscores that these changes can lead to a more accurate, flexible, and sustainable healthcare financial ecosystem for the U.S. The authors acknowledge crucial challenges that must be addressed, including workforce displacement, algorithm transparency, interoperability, data protection, ethical concerns, regulatory dynamics, and the importance of stakeholder training.

Pediatric capacity crisis: A framework and strategies to prepare for a pediatric surge. [4] Bongiorno DM et al., J Am Coll Emerg Physicians Open. 2024;5(1):e13093. Published 2024 Jan 16. PMID: 38230303

Perspectives, Experiences, and Opportunities of Academic Surgeons in the Era of Health Care Corporatization.[5] Sakowitz S et al., Ann Surg. 2025;282(1):1-10. PMID: 39811961

Locum Tenens and Pediatric Surgery: A Position Statement and Practice Guidelines from the American Pediatric Surgical Association (APSA) [6] Fahy AS et al., J Pediatr Surg. 2024 May 8:S0022-3468(24)00298-7. Epub ahead of print. PMID: 8806318.

Locum tenens is common in pediatric surgery, with at least 25-30% of practicing pediatric surgeons and groups reporting participation. Though the ACS provides recommended resource guidelines for the provision of surgical care to pediatric patients, there is a paucity of practical guidelines to address (1) special circumstances encountered in a locums setting, and (2) support for the pediatric surgeon participating in such an arrangement.

This Position Statement endorses locum tenens as an essential component of the surgical care of children across areas of diverse geography and resources. This is the first publication identifying specific recommendations for the 3 partners in administering pediatric surgical care to patients: the practicing locums surgeon, host organizations or surgeon practices, and placement agencies. The discussion highlights the paramount importance of quality and safety for patients as well as support for the individual pediatric surgeon. Additionally, the authors address several potential pitfalls and site-specific issues that could arise in the provision of care in these settings. The authors intend for this publication to serve as a basis for discussion between all involved parties, establishing “an ethically-sound framework and flexible, highly practical guidelines for the practice of locum tenens in pediatric surgery”.

Comanagement of Surgical Pediatric Patients in the Acute Care Inpatient Setting [7] Rosenberg RE et al., Pediatrics. 2024 Jan 1;153(1):e2023064775. PMID: 38105688

Comanagement of surgical patients occurs in varying degrees across multiple hospital settings, depending on available resources, medical staff, and organizational structure. Each healthcare organization tends to approach this strategy differently. The AAP has not previously published “formal guidelines for how such programs should be structured or care provided.”

By utilizing a modified Delphi procedure, multidisciplinary review of existing literature resulted in a list of key components to successful implementation of a comanagement program. This combination of published data and expert opinion provides the most current best practice recommendations for physician teams and health systems who participate in comanagement in both community and tertiary care settings.

The Surgical Mini-Sabbatical: A Path to Elevate Professional Engagement, Expand Patient Care, and Enhance Trainee Skills [8] Braet DJ et al., Ann Surg. 2024 Jun 21. Epub ahead of print. PMID: 38904108.

Sabbaticals have existed for over a century in academic institutions, though utilization is hampered by the challenge of meeting criteria for approval. Sabbaticals are generally 1 year or more in length, and though they can provide a number of benefits to both the physician and the organization, the many potential negative effects on the financial sustainability of the organization, distribution of work, and wellbeing of partners are often enough to prevent institutions from promoting such a program.

This is a perspectives piece, publicizing an innovative approach for academic institutions to support sabbaticals. Specifically, he suggests an alteration to the traditional sabbatical framework by (1) shortening the time to several months instead of year(s), (2) ensure that this “mini-sabbatical” is directed toward a specific gain that benefits the surgeon, the sending department, and the institution, and (3) providing a subsidy to the sending division or department to offset the expense and burden incurred with the absence. The author suggests that this strategy can promote surgeon wellness and retention while also supporting the mission and goals of the sponsoring organization.

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