The nursing facility in Hamden, Connecticut, had caring staff and well-kept grounds. What it lacked, in Apex Global Solutions’ account, was access to money it had already earned. Receivables totaled $1.7 million. Records were disorganized. Expenses went unpaid and penalties accumulated. The business was approaching closure while payments for its work remained out of reach.
- Apex runs billing, finance, purchasing and payroll for skilled nursing operators.
- Its advantage is coordinating the work between departments.
- Its advertised model uses flat monthly service fees, with software-only options too.
That is a useful place to begin understanding Apex. A nursing home has two clocks. One measures care delivered today. The other measures when someone pays for it. Between those clocks sit authorizations, claims, approvals, invoices and follow-up calls. Apex has made a business of working through that interval.
01 / The money was already earned
The Hamden intervention involved several jobs at once. Apex says it used its banking relationships to help increase the facility’s credit line, buying time while collections improved. It pursued outstanding receivables and organized invoices for payment approval. The share of the Medicaid population pending approval fell from 50% to 20%. According to the case study, profitability followed within months.
Notice the combination. Collecting old balances mattered. So did keeping the facility funded while the collection work happened. A billing specialist could pursue a claim; a cash-management team could explain whether the business could wait. Putting those tasks together was the point. The account illustrates a mechanism, rather than a promise that another facility would recover the same amount.
Less waiting on Medicaid approval.
02 / Two businesses, one handoff problem
Apex’s published history dates the combination of Apex Healthcare and Global Healthcare Services to 2017. Co-founders Jacob Karmel and Nathan Stern brought experience in skilled nursing finance and operations. Stern’s biography traces a centralized business office serving twelve facilities to 2003, then Global Healthcare Services to 2007. The combined business grew out of work the founders already understood.
The customer is the operator who owns one nursing facility or several and has acquired a second occupation: supervising the machinery behind the care. Apex’s current offering gathers four departments under one relationship. Revenue cycle handles billing and collection. Finance handles the books and cash. Purchasing watches spending. Payroll handles the recurring obligation nobody can postpone.
“We run the back office.
You run the business.”Apex Global Solutions / company positioning
The distinction from hiring four separate providers is responsibility for the joins. Who notices that a payer problem is becoming a liquidity problem? Who connects overtime with the financial forecast? Apex assigns an account manager across the relationship and named leads within each service. That is its competitive proposition: fewer unresolved questions traveling between departments.
03 / Software comes with someone to call
There is technology underneath the arrangement. Apex lists Workday for core financials, OnShift for workforce management, SilverKey for Medicaid eligibility support and TechFlow for revenue-cycle workflows. It describes daily bank reconciliation, reporting that drills down to individual transactions, and automation for repetitive preparation work. The useful output is a number an operator can investigate.
But the human layer remains prominent. A controller coordinates financial close and reporting, supported by accounts-payable, banking and cost-reporting specialists. Billing teams review aging receivables by payer and building. Purchasing includes contract management, order review, invoice matching and recovering credits. Payroll checks hours, rates and differentials before the run goes out. Each task has somewhere to land.
Operators can also license available software while retaining their own staff. That option reveals where Apex fits: between a software supplier and an outsourced operating department. The fully managed customer buys people and connected systems together. The software customer keeps responsibility for doing the work. Neither arrangement removes the need for someone to act on the information.
04 / The price is tied to the work
Apex advertises flat monthly fees per service, scoped around census and building count, rather than a percentage of collections or a charge per claim. Its published terms describe adding or removing services with thirty days’ notice. Onboarding begins with an audit and proceeds service by service; finance transitions can require a scheduled freeze to move the books.
The buying calculation should follow that scope. Compare the quoted fee with the internal work it replaces, the integrations it requires and the cash it can reasonably help collect. A higher collection rate is useful only when its definition is understood. A supply saving should survive comparison with the invoices. Measure the same things before and after.
05 / The other asset in the back office
Money is only part of what moves through these systems. In an April 2025 notice, Apex disclosed that information on its computers might have been accessed or acquired without authorization between June 18 and July 2, 2024. Potentially affected information included personal identifiers and, depending on the individual, health, claims or financial details.
The notice said Apex secured its environment and investigated with outside specialists. Its current website describes access controls and a SOC 2 Type II examination underway. For a buyer, permissions, retention and incident response belong alongside collection targets. An examination underway should be evaluated on that basis.
The useful lesson travels beyond nursing homes: trace unfinished work until someone owns the next action. Review old claims weekly. Connect expected receipts to upcoming payments. Administrative discipline can release trapped cash, but it still depends on valid claims, usable records and cooperation. It cannot substitute for adequate reimbursement or the people delivering care. The care clock keeps running.