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Payer Rate Negotiations [109]


Payer Rate Negotiations

Guest: Nathaniel Arana, NGA Healthcare

Nathaniel Arana of NGA Healthcare explains the nuances of payer rate negotiations and some of the pitfalls physicians face when trying to go it alone.

This issue (23:38):

  • Overview of the decline and stagnation in payer reimbursement over the last decade
  • How most providers tend to accept the rates and the difficulty in negotiating
  • How a provider can attempt to negotiate rates on their own and the pitfalls of doing it on your own
  • The types of leverage providers have and what goes into a value proposition
  • The importance of negotiating based on the right ‘fee schedule’ (for example, negotiating on the Medicare fee schedule versus the payer fee schedule)
  • How rate negotiations can make the difference between keeping a practice open and having to consolidate with a provider group