RCM ReFramed

About RCM ReFramed

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.

Publisher

GetixHealth

Category

business

Language

en

Explicit

No

First episode

3 Oct 2024

Latest episode

15 Sept 2026

Latest episodes

15 episodes in the feed.

1. 

   15 Sept 2026

   The Self-Pay Inversion: Why Insured Patients Are Now Your Hardest Collections | Ep 15 | RCM Reframed

   Self-pay used to mean uninsured. Now it means insured patients with $3,000 deductibles who behave financially like self-pay accounts, and the workflows most health systems built a decade ago are quietly destroying yield.In this episode of the RCM Reframed Podcast, Shawn Gretz sits down with Chris Spady, Senior Vice President of Revenue Cycle at Erlanger Health, to break down how patient collections have fundamentally inverted and what his team did about it. Chris shares the exact operating model changes that helped Erlanger double self-pay collections while shrinking self-pay AR to one-third of its prior size, and he does it without recycling the usual high-deductible talking points.What you will take away from this conversation.1. Why the average $27,000 family premium changes the self-pay conversation with your board and payers. 2. The day-60 auto-enrollment rule that replaces "statement and pray" with structured interest-free payment plans. 3. Why card-on-file is the single biggest lever in payment-plan completion economics. 4. How compassionate collections and expanded charity increased yield rather than reducing it. 5. What to do when patients start sending four-page ChatGPT-generated dispute letters citing regulations.Chris also reframes who actually holds risk in modern healthcare financing (spoiler, it may be the provider), and challenges the RAND-era logic still shaping benefit design today.Subscribe for more conversations with revenue cycle operators who have actually run the play.Learn more about GetixHealth: getixhealth.comConnect with Shawn Gretz: https://www.linkedin.com/in/shawn-gretz-mba-fhfma-3330b41/Connect with Chris Spady https://www.linkedin.com/in/chris-spady-b7abb549/Chapter Markers1. 00:00 - Introduction2. 01:00 - The biggest change in self-pay over the last decade3. 02:00 - The $27,000 family premium and what it means for RCM4. 04:15 - Do deductibles reduce utilization or just delay care5. 06:15 - The $400 problem and why patients delay6. 08:00 - Have hospitals become de facto lenders7. 10:00 - Who really owns the risk in healthcare financing8. 12:15 - Bad debt, charity trends, and the 25 to 35% administrative drag9. 14:20 - The employer as an under-recognized stakeholder10. 17:20 - Complexity masquerading as thoroughness11. 19:30 - Rejecting the bigger pile theory of self-pay collections12. 21:00 - Erlanger's day-60 auto-enrollment payment plan model13. 23:00 - Card on file, recourse vs no-recourse financing, and convenience14. 24:30 - Doubling collections while treating patients better15. 27:00 - Building a self-pay strategy from scratch16. 30:30 - AI-generated patient disputes and how to respond17. 34:00 - Shout-outs and closing thoughtsrevenue cycle management, RCM podcast, self-pay collections, patient collections, high deductible health plans, patient financial services, healthcare finance, denials management, payment plans, hospital revenue cycle, Erlanger Health, HFMA, patient billing, healthcare administration, medical debt

2. 

   2 Sept 2026

   Why Patient Financial Services Is Your Best Early-Warning System | Amanda Hines, Essentia Health

   Patient financial services sees what the rest of revenue cycle misses. In this episode of RCM Reframed, Amanda Hines of Essentia Health explains how upstream issues in registration, statements, and denials show up downstream in patient conversations first, and why that makes PFS one of the clearest signals of where the cycle is breaking. Host Shawn Gretz talks with Amanda about her path from making outbound collector calls to leading patient financial services at Essentia, her work revamping training in Essentia's patient financial services department, and how her team implemented Minnesota's 2023 and 2024 regulations alongside federal and 501(r) requirements. As Amanda puts it: "the longer you're in it, the more you start to realize that everything really is connected." What you'll take away: How registration errors, confusing statements, and unexplained denials surface first in patient financial services and what leaders can do with that signal Why a structured 3-4 week onboarding curriculum outperforms shadow-based training, and how poor training drives attrition before independence or within the first 60 days Amanda's "can vs. should" test for AI: repetitive transactional work is fair game, but anything touching a patient's balance or payment plan needs governance, QA, and human review Why chatbots work for information retrieval (statement copies, 1099 requests, simple payment plans) but fall short on empathy, judgment, and advocacy Why treating new regulation as enterprise change management - not a policy memo - and comparing notes with peer health systems creates a stronger operational case than solo interpretation 00:00 - Introduction 00:45 - From Collector to Director: Seeing RCM as an Ecosystem 02:43 - Pattern Recognition Starts With Training and Communication 04:59 - Career Growth Inside the Revenue Cycle 07:32 - Where Purpose Comes From in Patient Financial Services 10:44 - Revamping Training: Why 3-4 Weeks Beats Shadow-Based Onboarding 15:44 - Structured Training, Attrition, and Retention 17:44 - AI in RCM: Can It vs. Should It 19:00 - Don't Automate a Bad Process 21:00 - Chatbots vs. Human Advocacy in Patient Interactions 23:09 - Governance, QA, and Leveling Up Staff as Automation Scales 26:31 - Regulation as Enterprise Change Management 29:50 - Competitor Collaboration and Strength in Numbers 34:13 - Second-Order Consequences of Rushed Regulation 36:03 - Closing Thoughts

3. 

   21 Aug 2026

   Episode 6 Medicaid Policy Shifts and What They Mean

   Explore Medicaid enrollment challenges, policy impacts, and innovative solutions with Jennifer Wagner, Director of Medicaid Eligibility and Enrollment at the Center on Budget and Policy Priorities.

4. 

   30 Jul 2026

   Design for the Loops, Not the Line: Rebuilding Revenue Cycle after a Leadership Vacuum

   Sharlene Seidman left a 28-year career at Yale to lead revenue cycle at Johns Hopkins Medicine. Here's how she's rebuilding it.In this episode of RCM Reframed, host Shawn Gretz sits down with Sharlene Seidman, Vice President of Revenue Cycle at Johns Hopkins Medicine, to talk about what actually separates good rev cycle organizations from world-class ones. The conversation moves past AR days and cash collections into the operational decisions that determine performance: leader-employee pairing, structural design, succession planning, and silo-breaking.What you'll take away:* How to translate a "world-class" vision into concrete structural visuals your team can actually rally behind* Why the right-seat/wrong-leader diagnostic matters more than replacing underperformers* How to use stretch assignments (like patient financial experience) as leadership development laboratories* Why internal mobility is a retention strategy, not a flight risk* What future rev cycle leaders will need beyond workflow knowledge: AI fluency, vendor partnership skills, and cost-reduction creativity* Why rev cycle silos are especially damaging when the work is full of loops, not linear handoffsGuest: Sharlene Seidman, Vice President Revenue Cycle, Johns Hopkins Medicine Host: Shawn Gretz, President, Sales and Marketing, GetixHealth Produced by GetixHealthConnect with us: https://www.linkedin.com/company/getixhealth https://getixhealth.com/Subscribe for more conversations with rev cycle leaders.Chapter Markers1. 00:00 - Introduction2. 00:28 - Sharlene's Path Into Revenue Cycle3. 03:02 - Leaving Yale After 28 Years for Johns Hopkins4. 05:12 - Making the Leap: From Comfort to New Challenge5. 06:16 - Beyond AR Days: What Leadership Really Is6. 07:37 - Building Buy-In for a World-Class Vision7. 09:25 - Right Person, Right Seat: The Leader's Job8. 11:28 - When a New Leader connects with a Struggling Employee9. 13:10 - The Jungle Gym: Non-Linear Career Growth10. 14:36 - Recruiting Rev Cycle Leaders and Vendor Partnership Skills11. 17:18 - The Next 10 Years: AI, Cost, and Administrative Burden12. 20:40 - Succession Planning and Career Conversations13. 22:23 - Stretch Assignments: The Patient Financial Experience Example14. 24:27 - Why Hoarding Superstars Backfires15. 26:30 - Breaking Down Silos in a Non-Linear Revenue Cycle16. 27:30 - Building Cross-Functional Relationships Before Problems Hit17. 29:15 - Closing Thoughts

5. 

   23 Jul 2026

   The Denial Root Cause No Dashboard Will Show You | Sergio Quiej, Adventist Health

   A denial dashboard can tell you what happened. It usually cannot tell you why. In this episode, Sergio Quiej, Patient Financial Services Support Manager at Adventist Health and VP of the HFMA Lone Star Chapter, explains how a week spent observing surgery workflow uncovered the real cause behind an authorization denial pattern, helped cut the issue in half within three months, and supported a 1.5 FTE operational improvement within six months.Sergio also shares the $250,000 stop-loss claim that reframed his entire view of revenue cycle. As he puts it: "It wasn't the hospital. It wasn't the payer. Ultimately, it was the patient and that's community."Inside this conversation:* The $250,000 stop-loss claim that shifted his lens toward patient liability and community* Why "look beyond the metrics" became his working philosophy for denial management* How direct observation in surgery traced authorization denials to supply proximity and time pressure, not clinician intent* The live variance workflow: circulating nurse sends the item number so another person can start working it before coding and before the opportunity is missed* How to reverse-engineer a "no budget" objection by tying prevented write-offs to future departmental benefit* Operationalizing knowledge transfer through HFMA certification, shadowing, and shared AI prompt librariesLearn more about GetixHealth: getixhealth.comConnect with Sergio on LinkedIn: https://www.linkedin.com/in/therevenuecycleguy/ HFMA Lone Star Chapter: https://www.hfma.org/region-9/lone-star/ Subscribe for more RCM Reframe episodes: https://insights.getixhealth.com/podcastChapter Markers1. 00:00 - Introduction2. 01:07 - How Revenue Cycle Found Him (Not the Other Way Around)3. 02:43 - The $250,000 Stop-Loss Claim That Changed Everything4. 04:37 - Reporting Out to the Community, Not the Org Chart5. 06:55 - "We Have to Look Beyond the Metrics"6. 10:44 - Root Cause: Tracing a Denial Pattern to the Surgery Floor7. 11:26 - What He Actually Saw in the OR: Supply Proximity vs. Preference Cards8. 15:23 - Auditor vs. Partner: Earning Access to Clinical Workflows9. 16:28 - A Full Week in Surgery and the "Christmas in July" Question10. 22:42 - Scaling the Fix: Knowledge Transfer as an RCM Capability11. 27:24 - Why HFMA Involvement Compounds Over a Career12. 28:01 - Six Years in the Shadows Before Volunteering13. 30:54 - The Value of a Peer Network You Can Call14. 32:07 - "I Don't Know All the Answers, But I Know Someone Who Might"15. 32:38 - Closing ThoughtsTagsrevenue cycle management, denial management, prior authorization, authorization denials, prior auth denials, RCM podcast, healthcare finance, HFMA, patient financial services, root cause analysis, surgical authorization, operating room workflow, hospital revenue cycle, RCM process improvement, RCM leadership, Adventist Health, denial reduction

6. 

   13 Jul 2026

   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 management Why hospitals and Medicaid MCOs may suddenly find themselves aligned The "10x promise vs. 3x reality" of AI in revenue cycle Where AI actually pays off first - denial pattern detection and analytics How to use hybrid work as a tiered retention lever for patient access teams 00:00 - Introduction and Guest Background 01:00 - Why Sharing Across the RCM Community Matters 02:48 - The Endless Battles: Policy, Payers, Tech, and Daily Operations 04:30 - HR 1 and Medicaid Work Requirements Explained 07:15 - The Niagara Falls Story: How Thin Hospital Margins Really Are 08:24 - State-by-State Implementation and the Volunteer Hours Question 09:33 - Financial Counseling Becomes Case Management 11:20 - Adverse Selection: The Sicker Population Risk 12:17 - Where MCOs and Providers Suddenly Align 12:59 - Patient Access as the Front Door of the Revenue Cycle 13:37 - Prior Auth: The Goalpost Keeps Moving 14:41 - The Highway Analogy: Why Payer Inconsistency Breaks Automation 16:31 - You Can't Just Throw Bodies at the Problem Anymore 18:10 - Spending More to Preserve the Revenue We Already Earned 19:29 - Recruiting and Retaining Patient Access Staff Post-COVID 24:29 - The Remote Work Tradeoff in Patient Access 25:36 - Hybrid Work as a Performance-Based Retention Lever 27:11 - How Close Is AI to Actually Helping RCM Teams? 27:45 - The 10x Promise vs. 3x Reality of AI in Revenue Cycle 28:55 - Where AI Actually Pays Off First: Denial Pattern Detection 30:45 - The Voice AI Calling Voice AI Joke (That Isn't a Joke) 32:10 - Why Provider Workflow Variation Limits AI at Scale 34:08 - Junk Data In, Junk Data Out: The Stop Sign Problem 36:51 - Closing Thoughts Subscribe 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/ (https://www.linkedin.com/in/jonathandavis6/) ð Learn more about GetixHealth: https://www.getixhealth.com/ (https://www.getixhealth.com/) ð More episodes of RCM Reframe: https://insights.getixhealth.com/podcast (https://insights.getixhealth.com/podcast)

7. 

   6 Jul 2026

   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 performance The cash/revenue cycle fundamentals/culture sequence for distressed hospitals What boards actually need from an RCM update: risk, plan, and opportunity, not dashboards The credentialing-to-cash blind spot in physician onboarding What CFOs should build before stepping into the CEO seat: board communication, cross-functional process design, cash discipline, physician onboarding, and leadership alignment For hospital CFOs, VPs of Revenue Cycle, rural health executives, and mid-career RCM leaders weighing an executive path. Learn more about GetixHealth: Getixhealth.com (http://Getixhealth.com) Subscribe to RCM Reframed: https://www.youtube.com/channel/UCKKx-IcNcORCNmNl9RtTfTg Connect with us on LinkedIn: https://www.linkedin.com/company/getixhealth (https://www.linkedin.com/company/getixhealth)

8. 

   26 Jun 2026

   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/

9. 

   29 May 2026

   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/

10. 

    24 Apr 2026

    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.

11. 

    6 Nov 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.

12. 

    6 Nov 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.

13. 

    6 Nov 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.

14. 

    6 Nov 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.

15. 

    3 Oct 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/

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