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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.
How Can We Help
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