RCM ReFramed

GetixHealth
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Welcome to RCM ReFramed, the podcast dedicated to reshaping traditional views and approaches to Revenue Cycle Management (RCM) through innovative frameworks and strategic insights. Join us for the latest innovations, expert interviews, and discussions that will help enhance your RCM processes and shape the future of healthcare finance.

Episodes

  1. 15h ago

    When Financial Counseling Becomes Case Management

    Medicaid work requirements, shifting prior authorization rules, and AI hype are colliding and revenue cycle management teams are absorbing the impact. Jonathan Davis, Executive Director of Patient Access and Revenue Cycle Analytics at Yale New Haven Health (an ~$8B academic health system), joins host Shawn Gretz for a candid conversation on the operational reality behind the headlines.Jonathan breaks down the CMS interim final rules tied to HR 1, including the 80-hour monthly activity requirement and biannual re-enrollment, and explains why the bigger threat to providers may not be coverage loss itself - it's adverse selection toward a sicker remaining patient population. He also pushes back on the "AI will fix prior auth" narrative, arguing that payer fragmentation, not staffing, is the real bottleneck.What you'll take away: How Medicaid work requirements could transform financial counseling into ongoing case managementWhy hospitals and Medicaid MCOs may suddenly find themselves alignedThe "10x promise vs. 3x reality" of AI in revenue cycleWhere AI actually pays off first - denial pattern detection and analyticsHow to use hybrid work as a tiered retention lever for patient access teams00:00 - Introduction and Guest Background01:00 - Why Sharing Across the RCM Community Matters02:48 - The Endless Battles: Policy, Payers, Tech, and Daily Operations04:30 - HR 1 and Medicaid Work Requirements Explained07:15 - The Niagara Falls Story: How Thin Hospital Margins Really Are08:24 - State-by-State Implementation and the Volunteer Hours Question09:33 - Financial Counseling Becomes Case Management11:20 - Adverse Selection: The Sicker Population Risk12:17 - Where MCOs and Providers Suddenly Align12:59 - Patient Access as the Front Door of the Revenue Cycle13:37 - Prior Auth: The Goalpost Keeps Moving14:41 - The Highway Analogy: Why Payer Inconsistency Breaks Automation16:31 - You Can't Just Throw Bodies at the Problem Anymore18:10 - Spending More to Preserve the Revenue We Already Earned19:29 - Recruiting and Retaining Patient Access Staff Post-COVID24:29 - The Remote Work Tradeoff in Patient Access25:36 - Hybrid Work as a Performance-Based Retention Lever27:11 - How Close Is AI to Actually Helping RCM Teams?27:45 - The 10x Promise vs. 3x Reality of AI in Revenue Cycle28:55 - Where AI Actually Pays Off First: Denial Pattern Detection30:45 - The Voice AI Calling Voice AI Joke (That Isn't a Joke)32:10 - Why Provider Workflow Variation Limits AI at Scale34:08 - Junk Data In, Junk Data Out: The Stop Sign Problem36:51 - Closing ThoughtsSubscribe for more substantive RCM conversations with operators who have actually run the work.ð Connect with Jonathan Davis on LinkedIn: https://www.linkedin.com/in/jonathandavis6/ ð Learn more about GetixHealth: https://www.getixhealth.com/ ð More episodes of RCM Reframe: https://insights.getixhealth.com/podcast

    38 min

  2. Jul 6

    From Hospital CFO to Rural Hospital CEO: Shelie Shouse on Revenue Cycle, Cash, and Turnarounds

    Credentialing delays don't just slow onboarding. They delay payment. And when a rural hospital is under pressure, cash buys time to fix what comes next. In this conversation, Shelie Shouse explains why a background in reimbursement, revenue cycle, and hospital finance can prepare leaders for the CEO seat better than many traditional paths.Shelie is a CPA with an MBA in healthcare, a Fellow of HFMA and ACHE, and holds the Rural Health CEO certification through the National Rural Health Association. She walks through why revenue cycle gives leaders exposure to patient access, scheduling, coding, compliance, finance, and physician operations; how credentialing gaps quietly suppress reimbursement; why she watches cash above all else ("Cash. Specifically, sustainable operating cash flow."); and how she sequences a rural turnaround when liquidity is tight. Her organization has grown from 10 locations to 14 in recent years.What you'll take away: Why "numbers are outcomes, not causes" should change how finance leaders diagnose performanceThe cash/revenue cycle fundamentals/culture sequence for distressed hospitalsWhat boards actually need from an RCM update: risk, plan, and opportunity, not dashboardsThe credentialing-to-cash blind spot in physician onboardingWhat CFOs should build before stepping into the CEO seat: board communication, cross-functional process design, cash discipline, physician onboarding, and leadership alignmentFor hospital CFOs, VPs of Revenue Cycle, rural health executives, and mid-career RCM leaders weighing an executive path. Learn more about GetixHealth: Getixhealth.com Subscribe to RCM Reframed: https://www.youtube.com/channel/UCKKx-IcNcORCNmNl9RtTfTg Connect with us on LinkedIn: https://www.linkedin.com/company/getixhealth

    22 min

  3. Jun 26

    Turning Coding Needs into Coding Success with AI-RCM Reframed

    Autonomous coding doesn't fail because of the AI. It fails because of weak documentation, undocumented logic decisions, and missing physician engagement. Kelly Pearson, Director of Coding and CDI at MercyHealth, joins RCM Reframed to share the operator playbook behind their autonomous coding rollout, including what she would do differently with a second chance. Kelly walks through the operational pain points that drove MercyHealth to AI (coder shortages, pre-AR delays, backlog pressure), how the team assessed AI readiness through documentation quality, and why a layered audit model with 100% review at go-live was non-negotiable. She also explains the four-month implementation moment that prompted MercyHealth to create a dedicated coding project manager role, and how provider trending data is now driving targeted physician education. What you will take away: * Why documentation readiness, not AI capability, determines success * How to structure a layered audit model that scales without removing oversight * Why a dedicated coding project manager is essential from day one * How to engage physician advocates early and use AI trend data for targeted education * The future of the coder role: validation, analytics, education, and AI governance Subscribe for more conversations with revenue cycle operators who've actually done the work. Learn more about GetixHealth: getixhealth.com Connect with Kelly Pierson: https://www.linkedin.com/in/kelly-pierson-cpc-crc-499848145/

    25 min

  4. May 29

    Beyond Bots: What Rev Cycle Leaders Need to Rethink about AI.

    What does an actual RCM automation roadmap look like when it's built by operators, not vendors? Michael Laukaitis, Director of Revenue Cycle, Analytics, Accounting, and Quality Assurance at UT Southwestern, walks through the sequence his team followed over eight years: reporting first, then workflow analysis, then RPA, then AI, then agents. The result: roughly $4.5 million in FTE-equivalent savings over six years, including $1.5 million in the last year alone. The team built an AI agent named Sophie that surfaces SOPs, answers workflow questions, and compares Epic upgrade documents against existing procedures to flag what needs review. Their first agents handling Epic functionality and denials management are coming online in the next month and a half. Michael's warning to providers: he points to a 2016 Microsoft presentation that convinced him payers were already using automation and AI. Many provider RCM teams are still appealing those denials manually. As he put it: "The one thing I've seen organizations that have failed do is to just put bots in just to have bots." What you'll get from this conversation: * The reporting → analysis → RPA → AI → agents sequence, and why skipping steps creates "emotional support bots" * How Lean Six Sigma, Gemba walks, and the five whys come before any UiPath build * Why the SOP library is operational infrastructure, not a documentation chore — and how it became the foundation for an AI agent * A Medicaid coverage retrieval example: four staff handling roughly 16,000 accounts every three months versus a bot that could do the same workload every 16 days, with implications for timely filing and self-pay conversion * How to drive AI adoption with skeptical staff by anchoring on their three biggest weekly frustrations, not strategy slides * The case for embedding analytics in operations while strictly following IT governance * How to safely build AI literacy on a personal GPT when your security team hasn't approved enterprise access A practical playbook for anyone who owns denial rate, AR days, or net revenue yield. 🎙 Subscribe to RCM Reframed for more conversations with RCM operators. 🔗 Learn more: https://insights.getixhealth.com/podcast/beyond-bots 💼 Connect with Michael Laukaitis: https://www.linkedin.com/in/mikelaukaitis/

    36 min

  5. Apr 24

    The Impact of Experience Across the RCM Landscape-EP 7

    In this insightful conversation, host Shawn Gretz, President, Sales and Marketing for GetixHealth, sits down with Sandra Gubbine, Assistant Vice President, Revenue Cycle at AtlantiCare and discusses a wide variety of topics that touch on leadership in revenue cycle and more. Discussing everything from how Sandra found her way into healthcare, system conversions, and managing people in diverse areas of healthcare, to mentoring the next generation of leaders and volunteering, Shawn and Sandra explore issues that impact the healthcare revenue cycle and beyond.

    1h 10m

  6. 11/06/2024

    Leading Through Change: Insights from Miguel ‘Mike’ Vigo, VP of Revenue Cycle at UC San Diego Health

    In this engaging discussion, Beth interviews Miguel “Mike” Vigo, the Vice President of Revenue Cycle at UC San Diego Health, who shares insights from his first two years in the role. Mike highlights how he prioritized building relationships with his leadership team, implemented effective communication practices, and successfully integrated newly acquired hospitals while preserving a cohesive team culture. He also reflects on the challenges of adapting to California’s unique regulatory landscape compared to his previous experience in Illinois. Through open communication, trust, and a shared vision, Mike has successfully led UCSD Health through significant growth and change, keeping his team aligned and thriving.

    17 min
  7. Compliance in New Financial Assistance Laws: Mandatory Screening, Presumptive Eligibility, and Reporting Challenges for Revenue Cycle Leaders

    11/06/2024

    Compliance in New Financial Assistance Laws: Mandatory Screening, Presumptive Eligibility, and Reporting Challenges for Revenue Cycle Leaders

    In this podcast, Cheryl speaks with Laura Robbins, Chief Compliance Officer and Chief Operating Officer at Advocatia, about the recent legislative focus on expanding financial assistance programs in healthcare. They explore the motivations behind this push, common themes in state laws, and the challenges providers face in implementing these programs. Laura provides insights on presumptive eligibility screening, patient engagement, and industry best practices for workflows related to financial assistance. She underscores the importance of partnering with trusted providers who offer scalable technology solutions while maintaining a multi-channel approach to accommodate diverse patient preferences.

    14 min
  8. Building Payer Relationships, Aligning Teams, and Preparing for Cybersecurity Threats – Insights for RCM Leaders

    11/06/2024

    Building Payer Relationships, Aligning Teams, and Preparing for Cybersecurity Threats – Insights for RCM Leaders

    n this insightful discussion, Evan, a seasoned revenue cycle consultant, shares his perspective on the top challenges facing revenue cycle leaders today. From navigating ever-changing payer requirements to managing cybersecurity risks, Evan explains his approach to evaluating an organization’s revenue cycle health and developing effective strategies for improvement. He highlights the value of investing in team education, fostering strong payer relationships, and proactively preparing for potential system disruptions. Evan’s real-world experience offers valuable lessons for revenue cycle professionals at every level.

    27 min
  9. Insights from a Revenue Cycle VP: Establishing Operations at a New Organization

    11/06/2024

    Insights from a Revenue Cycle VP: Establishing Operations at a New Organization

    In this insightful discussion, Amanda, the Vice President of Revenue Cycle at ValleyWise Health, shares her experience leading revenue cycle operations over the past 18 months at a new organization. She highlights how she prioritized key initiatives, built a strong leadership team, improved cash flow, and navigated challenges posed by a complex payer mix. Amanda also emphasizes the importance of holding payers accountable, identifying denial trends, and maintaining open communication. Looking ahead, she expresses excitement about upcoming projects, including an Epic refuel, aimed at further optimizing their revenue cycle processes.

    18 min

  10. 10/03/2024

    Insights from Chief Information Officers in Healthcare

    In this panel discussion, CIOs from major healthcare organisations tackle key challenges in healthcare IT, including cybersecurity breaches and the role of AI in transforming patient care. Featuring power names in Healthcare industry David Stuart (CTO at Getixhealth) Follow : https://www.linkedin.com/in/david-stuart-58807a6/ Matt Chambers (CIO at at Baylor Scott & White Health) Follow: https://www.linkedin.com/in/matthewchambers/ William "Bill" Phillips (VP/CIO University Health) Follow: https://www.linkedin.com/in/william-phillips-ab18047/ Eric Ried (VP/CTO CHRISTUS Healthcare) Follow: https://www.linkedin.com/in/ericlried/

    1h 28m
  • 10 Episodes

About

Welcome to RCM ReFramed, the podcast dedicated to reshaping traditional views and approaches to Revenue Cycle Management (RCM) through innovative frameworks and strategic insights. Join us for the latest innovations, expert interviews, and discussions that will help enhance your RCM processes and shape the future of healthcare finance.

Information

  • Creator
    GetixHealth
  • Years Active
    2024 - 2026
  • Episodes
    10
  • Rating
    Clean
  • Copyright
    © GetixHealth
  • Show Website
    RCM ReFramed