Testimonials

A Florida Vascular OBL

Contract Renegotiations Increase

Addressing Unfair Rates

A Florida vascular group with an OBL had been facing low reimbursement for years. They were never been able to negotiate reimbursement rates on their own.

THE ISSUE

Payers in Florida are notoriously difficult to work, often never giving increases in reimbursement and often unilaterally decreasing rates. This group had suffered this exact scenario for years with UHC, BCBS, Humana, and most of their other major payer contracts.

THE SOLUTION

NGA Healthcare gathered all the payer contracts, fee schedules, and modeled a years worth of CPT data to benchmark the practice's rates. In many cases the group was being underpaid compared to their contract rates, which NGA Healthcare also helped to resolve. NGA crafted a value proposition using proprietary data, unique practice selling points, and regional rate comparisons. The value proposition was used to reinforce the practices leverage, along with negotiation skill sets and decades of experience from NGA Healthcare's team over the months long negotiation.

THE OUTCOME

After 8 months NGA Healthcare had successfully negotiated several the groups commercial contracts an average of 18% higher, resulting in hundreds of thousands of additional annual revenue.

A Kentucky Vascular Office/OBL

Maximizing a new group's reimbursement potential

NGA Healthcare was retained to obtain new contracts, negotiate carveouts for specific high value procedures, and credential a newly built OBL in Kentucky.

THE ISSUE

A talented surgeon was leaving another group to open a vascular clinic/OBL in an underserved area in Kentucky. NGA Healthcare knew that his new OBL would save the payers millions compared having the procedures performed by the local hospital systems. The physician needed expert guidance to credential his practice and maximize the reimbursement from his payer contracts.

THE SOLUTION

NGA Healthcare relayed the value of this new group and OBL to the payers and fought for carveouts on his OBL procedures. NGA also pushed the payers to credential the group in a timely fashion and presented the payers with a value proposition that demonstrated the cost savings the group represented to their networks.

THE OUTCOME

After 7 months, the client had all their major contracts and effective dates in hand. Even more importantly NGA helped them obtain rates that rivaled the local health systems with an average reimbursement 200% of Medicare for the commercial lines of business!