Insurance Contract Negotiation Services

This medium-sized practice has been open for 6 years and has a roster of 5 medical doctors and 3 mid-level providers. Annual Revenue is $4,650,000* broken down according to the following payer mix:

• Medicare - 25%
• Medicaid - 10%
• Commercial Payer 1 - 20%
• Commercial Payer 2 - 10%
• Commercial Payer 3 - 10%
• Commercial Payer 4 - 20%
• Commercial Payer 5 - 5%

After a comprehensive meeting to discuss their opportunities and what strategy we will be taking with the payers, we analyzed the practice’s CPT codes according to the payer mix above and weighted the number of encounters.

We found what each of the payers was reimbursing, as compared to Medicare, indicated in the graph below:

You’ll notice Payers 1, 2 and 3 are paying at a similar rate. Payer 4, on the other hand, is pulling the average down and is one of their largest payers. This was seriously impacting the practice’s finances. So, how did NGA proceed? We created an irrefutable value proposition and a strong negotiation strategy.

Using our long-standing health plan contacts, we started the several month-long negotiation process. Even after initially refusing any increases, the Payer ultimately agreed to an 18% increase over current rates from 78.25% to 96.25%. The result?

An extra $168,483 per year - year after year!

All of that revenue was essentially profit for the practice. No additional expenses were required to increase their bottom line.

All with just ONE payer. Imagine what that could mean for your practice.

How can my medical practice benefit from professional insurance contract negotiations?
Any group that has contracts with payers and has not negotiated their contracts in the last three years is most likely leaving money on the table. We find that most physicians need our services as they have never negotiated their contracts since they started their practice.

How much does it cost to negotiate contracts?
We provide our services on a fixed-fee basis. There are no 'surprise' bills outside of our agreement. We structure our fees based on the number of providers in the practice.

How much does it cost to negotiate contracts?
We provide our services on a fixed-fee basis. There are no 'surprise' bills outside of 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 time and resources. Below are the calculations we use to determine contract negotiation pricing:

(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 to 5 times the initial investment in just the first year.

In this case, that’s about $60,000 in additional revenue if we get the average increase from just one payer in the first year.

Can you guarantee that I will get an increase?
Nobody can guarantee an increase as there are far too many factors to consider. We can say 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 can I expect?
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. 

What is the typical timeline for completing the negotiation process?
On average renegotiations take 6-9 months from when we can commence the negotiations, and new contract negotiations average between 4-8 months from obtaining the practice information. The time ranges are highly dependent on the individual payers, practice specialty, and practice location.

How much involvement is required from my practice during contract negotiations?
Very little, as we have a team of expertise that can do the work for you. Your practice will be involved in the initial kickoff call where we will get the necessary data to model your potential current revenue and offers.  We will then meet with you to share the analysis.

After this point, our team will be the lead in all the negotiations and will not need any involvement from your practice. We are happy to meet with you to provide updates and details on any offers we receive. We do not accept any offers until we review with you and get your approval.

Can NGA Healthcare manage negotiations with multiple insurance providers simultaneously?
Yes, absolutely and we do this every day.  We have a team of over 50+ skilled negotiators, analysts, and a provider services team that have specialized and worked with almost all payers including United Healthcare, BCBS, etc.

What happens if the negotiation process does not yield the desired results?
This is very unlikely to occur as we’ve successfully negotiated for over 99% of our clients.  In the event that we aren’t able to obtain a new contract or negotiate an increase on an existing contract, we will return any qualifying and guaranteed initiation fees we’ve collected.

Does NGA Healthcare offer ongoing contract management and fee schedule updates as part of their services?
No, NGA Healthcare only charges initiation fees (which are guaranteed as long as we negotiate at least 5 health plans), and performance based fees.  Essentially, we don’t get paid unless we obtain a new contract or rate increase for your practice.

What steps are involved in the insurance contract negotiation process?
The first step after signing an agreement with NGA Healthcare and paying any associated initiation fee is the kickoff call. During the kickoff call we go over the welcome kit, which is an online form for sharing practice information needed for negotiations.

NGA then uses this information to submit offers and request any missing contracts/fee schedules needed to model the practice’s rates.  If it’s a new group then we are also submitting all the applications, and starting the negotiation process.

Once the increased offers or new contract offers are obtained, NGA Healthcare will share them with the practice and facilitate the signature of the agreements if the rates are acceptable.

What are the fees associated with contract negotiation services?
We charge an initiation fee (which is guaranteed if we don’t get any increases) that is determined by your practice size/specialty/location, flat fees for new contracts, or a percentage of the value brought to your practice.

What rate increases can typically be expected from successful negotiations?
Increases and rates vary greatly depending on a number of factors including: specialty, location, size of the group, facility type, age of the contracts, etc. 

Is it worthwhile for me to negotiate my insurance contracts?
Every group should be negotiating their payer contracts as often as possible. Negotiating contracts before you sign them is the most important time to negotiate.