If a practice has not reviewed its current contracts in the past 2 to 3 years, there is likely significant revenue being left on the table. Our long-standing payer relationships, contacts, and expertise in the health industry mean you have a team dedicated to understanding your practice’s needs and negotiating the rates that you deserve with the payers.
UnisLink and NGA Healthcare share the belief that private practices are an essential asset to payer networks and fundamental for patient health. NGA Healthcare is your partner to obtain payer contracts that allow each practice or facility to grow to its full potential!
Why Healthcare Providers Should Prioritize Rate Negotiations
If a practice hasn’t reviewed its current contracts in the past 2 to 3 years, there is likely significant revenue being left on the table. Private practices are an essential asset to payer networks and fundamental for patient health.
Healthcare reimbursement rates no longer keep pace with rising operational costs and inflation pressures. With private equity firms controlling 30% of physician practices and hospitals consolidating networks, individual providers risk being marginalized in payment structures. Five critical drivers make negotiations essential:
- Inflation: Medical supply costs rose 8.7% in 2024 alone, eroding profit margins.
- Shifting Power Dynamics: Health systems now control 58% of specialist referrals, limiting independent practices’ leverage.
- Regulatory Compliance: Updated CMS guidelines in 2025 require strict documentation for audit trails, increasing administrative burdens.
- Payer Strategies: 63% of insurers now use AI-driven claims denial systems, necessitating contract clarity on appeals processes.
- Alternative Payment Models: Value-based care contracts require renegotiating performance metrics and risk-sharing terms.
What Contract Elements Demand Scrutiny?
While reimbursement rates dominate discussions, operational clauses significantly impact revenue cycles. The “Law Firm Model” approach—where physicians collectively negotiate through legal experts—has reduced payment disputes by 41% in multi-specialty groups.
How Can Practices Prepare for 2025 Negotiations?
- Leverage Data Analytics: Benchmark rates against regional ASC/hospital OPPS increases (2.9% in 2025). Audit historical claim denials to identify contractual pain points.
- Address Compliance Early: Ensure licensing documentation meets updated HH1-1A standards for home health agencies. Implement real-time eligibility verification tools to reduce authorization delays.
- Counter Payer Tactics: Demand interest penalties for payments exceeding 30-day windows (14 states now mandate this). Negotiate “most favored nation” clauses to match competitor rate increases automatically.
What Trends Will Reshape 2025 Negotiations?
- Medicare Cuts: 2.93% fee schedule reduction forces commercial rate adjustments.
- Private Equity Influence: 44% of payer contracts now include carve-outs for PE-owned practices.
- State Interventions: 18 states are drafting laws to standardize prior authorization timelines.
Before anything else, NGA Healthcare performs a comprehensive review and generates analysis at a per CPT code level of each practice for each payer.
Want to master healthcare contract negotiations? Watch a webinar replay with expert Nathaniel Arana. He covers inflation’s impact, the rise of large health systems and private equity, effective negotiation models, managing costs & regulations, using data analytics, and compliance best practices. Get practical advice to help your practice thrive.
Why Choose NGA Healthcare?
NGA Healthcare is led by an experienced healthcare consulting expert. The company has a proven track record of improving practice profitability and specializes in contract negotiations across all medical specialties. NGA Healthcare believes that their long-standing payer relationships, contacts, and expertise in the health industry mean you have a team dedicated to understanding your practice’s needs and negotiating the rates that you deserve with the payers.
Ready to optimize your practice’s revenue? Visit ngahealthcare.com to schedule your comprehensive contract review and unlock your practice’s full financial potential.