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 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, 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 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.

How can my medical practice benefit from professional insurance contract negotiations?
Any group that has contracts with payers that has not been negotiated in the last three years.  In most cases, we find most physicians need our services as they have never negotiated their contracts since they started their practice.

What is the typical timeline for completing the negotiation process?
On average renegotiations take 7 months, and new contract negotiations average between 4-8 months, but it's highly dependent on the individual payers.

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.  The practice will be involved in the initial kickoff call wherein we will engage the practice to get the necessary data to model your potential current revenue and potential offers..  We will then meet with you if desired to share with you the analysis.  After this point, our team will be the lead in all the negotiations and will not need any involvement from the practice.  We are happy to meet with the practice to provide updates and any details on offers.  We do not accept any offers unless the provider approves.  

Can NGA Healthcare manage negotiations with multiple insurance providers simultaneously?
Yes, absolutely and we do every day.  We have a team of over 50+ including 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 fee we 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 bases fees.  Essentially, don’t get paid unless we obtain a new contract or increase.

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 client, 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.