Case Study: Contract Renegotiation Reimbursement Lift
Can Practices Renegotiate Payer Contracts?
Yes — and most never try. A practice engaged ProEnrollment after years of accepting the rates it was originally offered. Through market rate benchmarking and structured renegotiation, we lifted reimbursement on contracts the practice had assumed were fixed.
The Problem: Rates Frozen at the Original Offer
The practice had signed each payer contract at whatever rate was initially offered, then never revisited them. Years later, those rates had drifted well below market while the practice's volume and value to each network had grown substantially. Most practices never learn what competitors are paid for the same CPT codes, so they never know what to ask for.
The Action: Benchmark, Then Negotiate
We benchmarked the practice's contracted rates against market data for its specialty, geography, and volume tier — establishing concretely which contracts were underpaying and by how much. Armed with specifics rather than a general request, we approached each underperforming payer with a documented case: the practice's volume, quality metrics, network contribution, and the gap between its rates and market.
The Result: Reimbursement Lift on Existing Volume
The renegotiated contracts lifted reimbursement across the practice's existing patient volume — revenue gained without seeing a single additional patient or hiring a single additional provider. This is the most overlooked lever in practice economics: the same work, paid at a market-appropriate rate.
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