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 Subscribe for more substantive RCM conversations with operators who have actually run the work. ð Connect with Jonathan Davis on LinkedIn:   / jonathandavis6   ð Learn more about GetixHealth: https://www.getixhealth.com/ ð More episodes of RCM Reframe: https://insights.getixhealth.com/podcast Chapter Markers 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