You're leaving thousands of dollars on the table if you haven't negotiated your reimbursement rates
Most practices are not getting the rates they deserve. If you haven’t negotiated your reimbursement rates in the last three years, you’re leaving money on the table. Here, we will provide you with our costs to negotiate your rates and what you might expect during this process.
What is the process like?
- First, after you agree to work with us, we have an exploratory call where we discuss your strong points and what strategy we will be taking with the payers. During this time, we will put together an analysis of your procedure codes according to payer and determine which payers we will target (typically commercial plans, but we also work with Medicaid payers in states with Medicaid is delegated to a private contractor).
- You will be sent a list of information to provide us. Much of this information can be gathered by your administrative staff. This information will be used to put together a formal 'value proposition' that we will use to present to the appropriate connections at the insurance companies. Over the years, we have been fortunate enough to build connections at the payers and we understand the red tape. We know how to get the right information in front of the right people.
- Within 2-3 weeks, you will receive a copy of the value proposition. Once you approve it, we will submit to the payers and begin the negotiation process.
- From this point forward NGA will provide constant follow-up and phone calls with the payers. Sometimes we can get answers in 2 weeks, sometimes it can take months. The important part here is that while many negotiators may quit once they get a 'no' we keep going!
- After we agree to a rate proposition from the payer, we facilitate contracting implementation and effective date.
- If at any time after the negotiation you aren't getting the rates we agreed to, we will work on your behalf without additional charge to help get things in order for you!
How much does it cost?
We provide our services on a fixed-fee basis. There are no 'surprise' bills other than our agreement. We structure our fees based on the number of providers in the practice (Why? Because larger practices have a higher financial impact to the payers and the negotiations require substantial additional time and resources):
Number of providers * $1,000 * number of payer plans (minimum of 4 plans)
So, for example, a group of 2 MDs and 1 NP would be 3 * $1,000 * 4 plans = $12,000
Is this a substantial investment? Yes, it is. But understand that based on our track record, the average reimbursement negotiation provides you an increase that amounts conservatively 5 times the initial investment in just the first year.
(In this case, about $60,000 in additional revenue if we get the average increase from just one payer in just the first year).
Can you guarantee I will get an increase?
Nobody can every guarantee an increase. There are far too many factors to consider. We can say, however, that historically in 99% of cases, we are able to get at least one plan to increase rates that more than covers our fees and offers a generous return on your investment (generally 5X in just the first year). This is the reason why we work with more than one of your plans - it increases the chances that we will get at least one contract increased.
How big of an increase?
Increases are generally in the 10% to 20% range. Certainly, it's better to focus on the impact of the increase. a 7% increase on your largest payer is worth much more than 20% of your lowest. Reimbursement increases have significant impacts to your bottom line and profit/salary because the additional revenue requires no additional overheard or work.