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

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

1. 00:00 - Introduction
2. 00:45 - From Collector to Director: Seeing RCM as an Ecosystem
3. 02:43 - Pattern Recognition Starts With Training and Communication
4. 04:59 - Career Growth Inside the Revenue Cycle
5. 07:32 - Where Purpose Comes From in Patient Financial Services
6. 10:44 - Revamping Training: Why 3-4 Weeks Beats Shadow-Based Onboarding
7. 15:44 - Structured Training, Attrition, and Retention
8. 17:44 - AI in RCM: Can It vs. Should It
9. 19:00 - Don't Automate a Bad Process
10. 21:00 - Chatbots vs. Human Advocacy in Patient Interactions
11. 23:09 - Governance, QA, and Leveling Up Staff as Automation Scales
12. 26:31 - Regulation as Enterprise Change Management
13. 29:50 - Competitor Collaboration and Strength in Numbers
14. 34:13 - Second-Order Consequences of Rushed Regulation
15. 36:03 - Closing Thoughts

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.

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

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

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

1. 00:00 - Introduction and Guest Background
2. 01:00 - Why Sharing Across the RCM Community Matters
3. 02:48 - The Endless Battles: Policy, Payers, Tech, and Daily Operations
4. 04:30 - HR 1 and Medicaid Work Requirements Explained
5. 07:15 - The Niagara Falls Story: How Thin Hospital Margins Really Are
6. 08:24 - State-by-State Implementation and the Volunteer Hours Question
7. 09:33 - Financial Counseling Becomes Case Management
8. 11:20 - Adverse Selection: The Sicker Population Risk
9. 12:17 - Where MCOs and Providers Suddenly Align
10. 12:59 - Patient Access as the Front Door of the Revenue Cycle
11. 13:37 - Prior Auth: The Goalpost Keeps Moving
12. 14:41 - The Highway Analogy: Why Payer Inconsistency Breaks Automation
13. 16:31 - You Can't Just Throw Bodies at the Problem Anymore
14. 18:10 - Spending More to Preserve the Revenue We Already Earned
15. 19:29 - Recruiting and Retaining Patient Access Staff Post-COVID
16. 24:29 - The Remote Work Tradeoff in Patient Access
17. 25:36 - Hybrid Work as a Performance-Based Retention Lever
18. 27:11 - How Close Is AI to Actually Helping RCM Teams?
19. 27:45 - The 10x Promise vs. 3x Reality of AI in Revenue Cycle
20. 28:55 - Where AI Actually Pays Off First: Denial Pattern Detection
21. 30:45 - The Voice AI Calling Voice AI Joke (That Isn't a Joke)
22. 32:10 - Why Provider Workflow Variation Limits AI at Scale
23. 34:08 - Junk Data In, Junk Data Out: The Stop Sign Problem
24. 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/
ð Learn more about GetixHealth: https://www.getixhealth.com/
ð More episodes of RCM Reframe: https://insights.getixhealth.com/podcast

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

Subscribe to RCM Reframed: https://www.youtube.com/channel/UCKKx-IcNcORCNmNl9RtTfTg

Connect with us on LinkedIn: https://www.linkedin.com/company/getixhealth

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/

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/

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.