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Negotiation Services

Most Practices aren't getting the rates that they deserve. NGA Healthcare has a success rate of 100% in negotiating contracts; we have been able to negotiate at least one major contract for each of our clients. The result is an increase in reimbursement that quickly covers the cost of our services.

Preparation

Consultation and Proposal

We set up a call to discuss the status of a Clients contracts, and to understand the pain points for each practice. NGA submits a proposal to the client, outlining the process, fees, and the plans NGA will pursue increase from.

Information Provided by Client

Once a client procures our services, we send them a list of data points and information that we'll need to analyze their rates and create a value proposition.

Analysis of Payer Reimbursements

We benchmark your practices’ allowable rates by individual CPT against Medicare to understand your bottom line on a granular level.

Process

Value Proposition Submitted to Plans

An in depth value proposition is created that highlights all of the practice’s unique capabilities and savings for to the health plans.

Negotiations with Plans

We submit the value proposition to each plan and initiate the negotiation process. Over the course of weeks and months we make the irrefutable case for an increase to the plans. We don’t take “No" for an answer.

Higher Rates for your Practice

NGA is committed to getting our clients higher rates, even after months of stalling and delays, NGA sticks with the negotiations. We don’t stop until we get the increase your practice is entitled to.

Case Study of a Medium-Sized Practice:

This medium-sized practice has been open for 6 years and has a roster comprised of 5 medical doctors and 3 mid-level providers. Annual Revenue is $4,650,000* broken down according to the following payment 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 scrutinize and discuss our strategy, leverage, and competitive advantages, we analyzed the practice’s CPT codes according to the payers above and weighted the number of encounters.

We found what each of the payers was reimbursing, as compared to Medicare…

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 Payer 4 is one of our 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.

Timeline

Timelines for negotiation services are highly dependent on the payers. Most negotiations take on average between 3 and 6 months between the signing of the contract and the signing of the addendum with increased rates. NGA Healthcare works tirelessly to obtain your practice the increase it deserves, and our entire payment structure was designed to align our incentives with your practice. The sooner we get you a large rate increase, the sooner we all benefit.

Pricing

Initial Fee

Our initiation fee covers all work and time for our services. Even if negotiation takes months, dozens of calls, and hundreds of emails, we never charge for additional hours. The fee is dependent on the specialty, size of the practice, and the number of plans to be negotiated.

 

Performance Bonuses

We build in a bonus structure based on the percentage increases we are able to obtain per health plan. We are incentivized to get a higher increase that will greatly increase the bottom line for your practice.

Specialties We Have Worked With

Ambulatory Surgery Centers (ASCS)

Allergy & Immunology

Addiction and Drug Treatment Centers Anesthesiology (Pain Centers)

Behavioral Health (Psychiatry/Psychology) Cardiology

Dermatology

Dentistry

Ear, Nose, and Throat

(ENT/Audiology/Otolaryngology)

Emergency Medicine

Gastroenterology

Interventional Radiology

Imaging Centers Labs

Neurology

Obstetrics & Gynecology

OBLs (Office Based Labs)

Ophthalmology & Optometry

Orthopedic

Pain Management

Primary Care

Podiatry

Radiology-Diagnostic

Surgery (General, Eye, Endovascular, Hand, Orthopedic, Retinal, Spinal, Vascular, etc)

Urology

States we work in ...

All 50 States!

Schedule a Meeting

Our Partners

How Can We Help

Connect With Us

By Phone

(520) 333-2076

In Person

Mon-Fri: 9am-5pm

Via Email

info@ngahealthcare.com