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Through some digging, Aroris learned before it was officially announced that a new regional provider would take over. Moving quickly, Aroris conducted an in-depth analysis of the provider's reimbursement history and regional data to make the case for an upward rate adjustment.

Upon analyzing each payer contract for all four entities, Aroris identified eleven payer contracts eligible for negotiating new reimbursement rates. In the past, many of these payers told the provider that their reimbursement rates were non-negotiable. However, armed with the latest market data, a determined spirit, and a compelling case that preserving the client's viability was critical to the well-being of its community, these once intractable payers agreed to make rate adjustments.

Aroris started by first understanding the pain points of both the provider and the payer. Then, it dove deep into the data of their shared history and benchmarked the findings against market-level figures for their region. This work manifested in a compelling business case that clearly demonstrated reimbursement revenues needed to align with the value the practice provided to its patients and community.

Leveraging its proprietary digital platform, Aroris' experts scoured the contracts and reimbursement history of all the group's commercial payers to spot revenue opportunities. Aroris then assembled rational cases for rate increases across their roster of insurers. Expert negotiators then relentlessly pressed those cases to a host of positive outcomes.

Aroris stepped in to lead the negotiations and worked with the payer to carve out the highly utilized code to be reimbursed at a higher, fair market rate. In parallel, Aroris showed how the payer was underpaying in reimbursements in other areas and achieved increases on additional codes that were strategically important to the practice's growth.

Aroris’s analysis of the individual contracts indicated the payer was reimbursing codes at 4% less than market average. Therefore, Aroris’ objective with the payer was twofold: (1) Convince the payer to consolidate the 15 individual contracts into one group contract to simplify the administration effort. And (2) promote and advocate the unique advantages of the specialty practice and why increased reimbursement rates above the market average were essential to the payer’s competitive offering in that market.

Aroris’s analysis revealed the payer had been reimbursing the clinic and ASC services below market average. Aroris’ goals were: (1) engage the payer and oppose the fee schedule changes through a compelling business case. And (2) negotiate for fair-market reimbursement levels for the clinic and ASC.

An existing rate structure that rolled up all CPT codes into four distinct categories made it challenging to paint a complete reimbursement picture. Yet, armed with analytic tools and expertise in the specialty, the Aroris team modeled which of the rates provided the most significant revenue impact and made it the strategic focus of the negotiations.

Aroris made it clear to the payer that they must adjust their rates to ensure the practice's viability. Twice, the payer refused to increase reimbursement rates. Employing an unrelenting will and an appeal to good faith and fair dealing, the payer capitulated by offering a new three-year deal. Amazingly, the offer didn't include rate increases for years two and three.