Presentation on theme: "Carolyn Milburn, President"— Presentation transcript:
1Carolyn Milburn, President Prime Your Background for SuccessCarolyn Milburn, President
2Milburn Partners, Inc.Our firm was founded in 2001 with offices in Dallas and HoustonClients span from the Mid-Atlantic to California, with a focus on Revenue Cycle, Finance and Accounting, exclusively in healthcareWe feel our Client and Candidate network is both broad and deepOver half of our current searches require candidates that have experience in Revenue CycleIn 2013, for example, we successfully completed 5 Vice President of Revenue Cycle searches, in DFW alone, all in a 4 week span
3Appointment Scheduling Resubmission & Appeals Patient RegistrationPatient ExamService CodingCharge EntryClaims SubmissionPayment ProcessingResubmission & Appeals2nd Claims/Patient BillingA/R Follow-UpCollection AgencyWhat is Revenue Cycle?The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue."
4Career path in revenue Cycle Business DegreeHIM Degree/RHITRN DegreeAccounting DegreeBachelor’s of ScienceFinance DegreeClinical AnalystFinancial AnalystBODMgr. Rev CycleRev AccountantAccess ServicesDirectorSr. DirectorVice PresidentC-Level
5Revenue Cycle Management The Key Stakeholders Include:VP Revenue CycleVP Managed Care/ContractingDirector of Patient Access/RegistrationDirector of Professional BillingDirector of Revenue CycleDirector of Business OfficeDirector of Patient Financial ServicesManager of Revenue CycleRevenue Cycle AnalystPractice Administrator/Office ManagerRevenue Cycle Consultants
6Among the most important financial priorities: Survey of hospital executives indicates that revenue integrity is the most important component of the financial health of their organizations.57 hospital executives polled, 34 were C level1/3 affiliated with large hospitals and healthcare systems, remainder split between critical access, community and medium-sized facilitiesAmong the most important financial priorities:Receiving proper reimbursement from private payersComplexity of reimbursement policies from government payersEnsuring optimal reimbursements for pharmaceuticals and medical supplies1/2 of executives added additional staff to address revenue integrity issues1/4 established separate revenue integrity departmentsThe report by Atlanta-based revenue cycle software provider Craneware Inc. polled 57 hospital executives, of whom 34 were C-suite level employees. About a third were affiliated with large hospitals and healthcare systems with the remainder split between critical access, community and medium-sized facilities.Among the most important financial priorities was receiving proper reimbursement from private payers, the complexity of reimbursement policies from government payers and ensuring optimal reimbursements for pharmaceuticals and medical supplies.In response, more than half of hospitals executives say they have added additional staff to address revenue integrity issues, while one-quarter went so far as to establish separate revenue integrity departments.
12Can you be an effective leader? Formulate your organization's revenue cycle operations for an uncertain futureUse less resources and continue to advance performanceConnect financial data with clinical dataImprove the overall value delivered to patients and the community Think strategically and plan proactivelyBeing a revenue cycle leader in healthcare is an increasingly multifaceted and challenging job. Leaders must formulate their organization's revenue cycle operations for an uncertain future, while using less resources and continuing to advance performance. Revenue cycle leaders play in important role in connecting financial data with clinical data, with the goal of improving the overall value delivered to patients and the community. The challenges revenue cycle leaders face are as difficult as they have ever been. Effective leaders will be those who think strategically and plan proactively, while simultaneously inspiring and managing their crews through tough times.
13Working Towards C Level Status Major changes in the industry are requiring health systems to rethink and revamp their stratagem. What is required?Identify and target patient populationsAchieve clinical integration across the network, and leverage data from anywhere and everywhereActionable insight into the financial performance of the group and the health of the patient populationVisibility across networks that can be influenced and acted upon at the initial point of contact with patientsManage the networks/patient populations, no matter what the payment model might beHarmonize data from multiple systems (EHR, practice management, claims)-turn it into insight which can then become action directly in an organization’s existing workflowsHealth organizations are seeing a growing need to develop network strategies that address the entire continuum of care: Identifying and targeting patient populations, achieving clinical integration across their network, and leveraging data from anywhere and everywhere .For effective revenue cycle management, to achieve both revenue and outcome goals, these organizations need actionable insight into the financial performance of their group and the health of their patient population. With visibility across their network that can be influenced and acted upon at the initial point of contact with patients, the goals of these larger health systems are achievable.To gain this actionable insight, health systems need people that can deliver it, and help them manage their networks and patient populations, no matter what the payment model might be. What is required? Leaders that can harmonize data from multiple systems (EHR, practice management, claims) and turn it into insight which can then become action directly in an organization’s existing workflows.
14The Chief Revenue Officer CROs are accountable for all revenue-related functions - marketing, sales, customer support, pricing and revenue management.Teams up with Executives to create and convey the company’s ideas and revenue strategies across all relevant functions to ensure the right goals are defined and metRegularly analyzes productivity and effectiveness to create market positioning and competitive advantages, and determines budget trade- offs to improve and develop sustainable resultsRecognizes the differences between marketing and sales, and creates processes to ensure their synchronization across the full revenue cycle get the best resultsHas a long-term, integrated perspective while striving to drive quarterly revenue results
15The Chief Strategy Officer The best way to describe the role of a CSO? There is no clearly defined role.Capable of seeing all the pieces on the board and able to see several moves into the future. (to infinity…and beyond!)Some formulate strategy, others execute strategy, others do both.Might act as “internal consultants,” or as experts because they have proficiency in particular areas (revenue cycle management, managed care-contracting, patient financial services, practice operations)Responsible for understanding how market forces are transforming and how those changes will affect the services patients will need in the future.
16The Chief Strategy Officer Revenue Cycle leaders who want to advance to CSOs will need to be able to:Consolidate network revenue cycle and productivity dataUse analytical tools that display information clearly and accessiblyHave actionable insight into patient financial services, collections, referrals, denials, DAR, etc.The ability to easily “slice and dice” data and share performance resultsBenchmark tracking and performance comparison by practice, specialty, or geography
17Building Your Executive Profile Consider how these positions are changing, how else you might be able to align your resume with those changes?You’ll need years and years worth of learning experiences from various managerial and director positions. (don’t get complacent!)Experience and demonstrable skills are the most important things that employers look for in C-Level Executives.
18Market TrendsDemand for ancillary healthcare companies and consultant roles have doubled over the past yearCentralization of processes as consolidations and reimbursements are cutHospital systems are developing mini regional offices
19In Closing…Demand for health care, and thus the need for more health care workers, is expected to keep growing.Revenue Cycle roles are the backbone of well run organizationsDevelop plans to recruit and retain the talent that will tackle the challenges your organizations are facingPatiently growing the talent and skills of your team is criticalIndustry consolidation will be a great way to upgrade the quality of your workers
20Salary, Education and Certification HIM ProfessionalsHealth Information Technology is one of the fastest growing occupationsHIM graduates with an Associate’s earn $35,000 to $45,000 annuallyHIM graduates with a Bachelor’s start at $50,000 to $60,000In 5 years, can potentially earn upwards of $65,000 to $85,000(RHIAs) often hold managerial positions related to these functions. In a recent survey, AHIMA found more than half of RHIA respondents were directors, managers, or consultants, with almost 31 percent serving as HIM directors.(RHITs) often specialize in coding diagnoses and procedures in patient records for reimbursement and research. RHITs may serve as cancer registrars or hold a supervisory position.
21Practice Settings for HIM Professionals Traditional SettingsNon-Traditional SettingsConsulting firmsGovernment agenciesLaw firmsInsurance companiesCorrectional facilitiesExtended care facilitiesPharmaceutical ResearchStatisticianClinical Trials CoordinatorData ManagerInformation TechnologySystem AnalystProject ManagerMedical Software CompaniesSoftware DesignerSoftware TesterManagement, HIM (Medical Records)Tumor registryCodingTrauma registry (E.R.)TranscriptionQuality ImprovementRelease of InformationPatient AdmissionsCompliance AuditorPhysician AccreditationUtilization ReviewPhysician officesRisk Management
22Typical Salary for HIM Professionals Milburn Partners’ data based on placements from 2012-Present