Associates in Medical Billing - Physician Billing Service Projects

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Managed Care Engagement Results:

*Suburban physician billing service and consulting firm:*
		Planned, founded and developed a local suburban physician billing service and consulting firm and negotiated its sale to a local management team
*Suburban Midwest hospital and physician consulting firm:*
		Founded and developed a comprehensive consulting practice employing over 30 fulltime consultants and generating more than $5 million in revenues
		Developed a product line focused on managed care contracting, managed care financial analysis, information systems implementation, revenue cycle management, receivable reduction, lost revenue recovery, team building and other services
		Developed a client base of over 50 hospitals, physician practices and ancillary provider organizations
*A fifty + (50+) physician Midwest multi-specialty group practice:*
		Analyzed, developed and implemented an entirely new physician compensation model that provided full costing of all ancillary revenue and service lines of business
		Assisted with the development of a feasibility model for the development of a new outpatient surgical center
*Urban Midwest HMO, PPO, Insurance Company and Third Party Administrator:*
		Performed financial turnaround resulting in significant new and profitable growth
		Implemented new information systems, expanded the product lines, implemented new provider contracting methodologies/incentives
		Negotiated the sale of this organization to a national insurance company
*Urban Midwest Ancillary Provider Organization:*
		Developed and implemented new EDI, clearinghouse and billing automation strategies
*Urban Midwest Community Hospital with over 300 beds:*
		Negotiated the bulk settlement of over $1 million in managed care receivables
		A Midwest Management Services Organization (MSO) with over 350,000 lives:
		Renegotiated full risk capitation with one payor resulting in over $2.5 million in additional revenue
		Organized and implemented team building project to improve communication between entire management team resulting in increased trust, cooperation and productivity
		Assisted with the automation of claims processing through several clearinghouses resulting in over $3 million in administrative cost savings and over 50% "first pass auto-adjudication" of claims
*A Midwest suburban community hospital with 250+ beds and its PHO:*
		Performed evaluation and analysis of all payor contracts, provided recommendations for changes in language, terms, rate methodology and overall contract pricing
		Renegotiated all payor agreements for hospital and PHO resulting in revenues increases of $12-$15 million (or 10-15% of net revenues) (with no change in volumes) for the hospital and $5 - $7 million for the PHO, functioned as an "outsourced" managed care department
		Identified an outsourced alternative to emergency room billing resulting in an overall increase in emergency room revenues of 18%
		Assisted with the transition to non-global hospital-based physician billing resulting in a savings to the hospital of 5% of revenues
*A Midwest suburban three (3) hospital health system:*
		Performed evaluation and analysis of specific managed care payor contracts and identified increased net revenue opportunities of 18-22% (with no change in volumes)
		Developed new contracting strategy, pricing methodologies, language and assisted with the renegotiation of payer contracts<
		Developed new data analysis financial models to more appropriately evaluate payer contract results
*An urban catholic community hospital located in the Midwest with 250+ beds and its affiliated IPA:*
		Assisted with the recommendation and dissolution of the underfunded and underperforming IPA and transfer of membership to a newly created PHO resulting in annual savings of over $2 million and ongoing membership revenue of over $3 million with no membership or financial losses to any of the participating physicians
		Developed and installed a claims payment information system for final claims payout of IPA liabilities (timely dissolution allowed for the full payment to all creditors resulting in no negative publicity)
*An urban tertiary medical center located in the Midwest with over 700 beds:*
		Performed evaluation and analysis of all payor contracts and provided recommendations for changes in language, terms, rate methodology and overall contract pricing which would result in over $100 million increase in net revenues per year (with no change in volumes)
		A suburban ancillary provider located in the Midwest that provides among other services, home health, durable medical equipment, sleep programs, private duty nursing:
		Analyzed, developed and implemented a new revenue cycle management process for the entire business office (registration through collection) resulting in significant increases in employee satisfaction, administrative cost savings and cash flows
		Assisted with the negotiation/renegotiation of new managed care payor contracts and development of new business relationships resulting in increased net revenues of over $2 million
*An urban hospital located in the Midwest with over 250 beds:*
		Assisted with the negotiation/renegotiation of several managed care payor contracts and development of new business relationships resulting in increased net revenues of over $1 million
*A rural hospital located in the Midwest with over 350 beds:*
		Performed evaluation and analysis of all payor contracts and provided recommendations for changes in language, terms, rate methodology and overall contract pricing which would result in over $10 million increase in net revenues per year (with no change in volumes)
		Assisted with the negotiation/renegotiation of a significant managed care payor contract resulting in increased net revenues of over $1 million (with no change in volumes)
*A rural provider owned HMO, PPO and Insurance Company located in the Upper Midwest with over 35,000 lives:*
		While providing interim CFO/COO services, developed in-house financial capabilities (previously 90% outsourced) resulting in a reduction in administrative expenses of over $5 million per year, implemented a new information system resulting in administrative cost savings of over $3 million, expanded market service area allowing for the enrollment of over 7500 new members (increasing revenues by over $18 million per year), developed an acceptable premium rate model allowing for the enrollment of a new group consisting of over 10,000 new members resulting in an increase in annual revenues of over $30 million
		Updated rate models, rate filings and overall rate increase by over 12% resulting in additional annual revenues of over $3 million
*A large, well-known Blue Cross Blue Shield plan with over 2 million members:*
		Assisted with the implementation of a company-wide information system
		Developed an executive reporting system utilizing data warehousing technology with over 400 new reports covering all operating departments as well as executive management
		Renegotiated the five (5) largest PHO contracts covering over 800,000 lives

Projects

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