1. Apogee Consulting Group
Presented By:
Russell Mancini & Frank Nitto
3. Company Profile In Business Since 1996
Headquarters -Houston, Texas
18 Employees
Managed Care and Medicare Compliance Review Services
4. APOGEE’S PRODUCTS & SERVICES
6. Managed Care Solutions
7. Are You at Risk? Volume of Contracts > 15%
Complex Contracts (Cardiovascular, NICU, Trauma, Burn, etc.)
Contracts with Multiple Per Diems and Case
Rates in Combination
Contracts with Outlier Clauses
8. MPR Project Objectives Identify and Recover Cash
Actions, Procedures, Integration Training to
Minimize Revenue “Leakage”
Provide Information and Strategies in Future
Contract Negotiations
9. Identify and Recover Cash
10. #1 Identify and Recover Cash Survey Hospital Payment Policies and
Procedures
Review Contracts to Identify Key Areas at Risk
Compare Contracts to Financial Data
Identify Underpayments
Follow-up with Payer to Recover Cash
Provide Monthly Reports Identifying Source of
Underpayments
11. Cash Identified & Collected
12. Type of Error Summary
13. Top 10 Insurance Companies
14. $ Recovered Per Type of Error
15. Needle in a Haystack
16. Minimize Future Cash Leakage
17. # 2 Minimize Future Cash Leakage 1. Identify Problem Sources
2. Recommend and/or Implement Solutions
3. Train Staff to Identify and Resolve
Incorrect Payments
4. Train Staff to Negotiate Higher
Reimbursements
18. Future Contract Negotiations
19. #3 Future Contract Negotiations 1. Analyze Historical Reimbursement Activity
2. Recommend Changes to Contract
Language
3. Suggest Commonly Used Contract
Provisions and Rate Structures
4. Provide General Market Comparison of
Contract Rates & Structures
Providing Information to Negotiate Higher
Reimbursement
20. Impact on Payer Relations No Impact on Future Negotiations
21. Client Interface
22. Client Interface How Does Apogee Minimize Hospital Staff Time and Still Achieve Project Objectives?
24. Client Interface Feasibility Study (1-5 days)
Audit (4-6 months)
Project Conclusions and Recommendations
25. Apogee Project Team
26. Apogee Project Team Professional, Experienced, Diverse
Accountants, Financial Analysts, MBAs
RNs, Case Managers and Utilization Review
Information System Specialists
Contract (Legal) Specialists
27. Project Overview
28. Project Overview
29. Project Fee Options Contingency
Hourly Rate with Incentives
30. Apogee Consulting Group
Healthcare Professionals Providing Solutions In Managed Care
