National Practice Advocacy Group
Payer contract negotiation for medical practices.
NPAG helps independent practice owners review commercial insurance contracts, compare reimbursement rates and pursue better payer terms.
- Any commercial contract more than five years old is eligible to be renegotiated — often at higher rates.
- We show you, code by code, what your work should earn.
- Then we negotiate it, and the increase compounds on every future claim.
For practices billing $1M+ in annual commercial revenue. Review takes 30 minutes.
- Contract terms
- Renewal windows and reimbursement clauses
- CPT rates
- Code-level fee schedule comparisons
- Payer priorities
- A plan built around your practice’s payer mix
When should a practice review its payer contracts?
Start with agreements that have renewed unchanged, fee schedules that no longer reflect your costs, or payment terms your billing team cannot reconcile. Contract review identifies what needs attention before you approach a payer.
Contracts that never get questioned
Evergreen clauses renew your agreement at the same rates indefinitely unless someone objects before a buried deadline.
Benchmarks you can't see
A national average cannot tell you what your specific payer should pay. Compare like-for-like codes, contract terms and available market evidence.
Language that erodes the rate
Downcoding, recoupment windows, and unilateral amendments cut your effective reimbursement without touching the schedule.
Time used against you
Payer review, counteroffers and amendments take sustained follow-up. A renewal deadline can arrive before the discussion is finished.
How commercial insurance contract renegotiation works
Start with a conversation, separate analysis from negotiation, and decide with your practice’s actual numbers.
1 · Free rate review
Share your specialty, payer mix and commercial billing in a 30-minute strategy call. We discuss which agreements and fee schedules need review.
2 · Opportunity report
A paid contract analysis compares your CPT rates with available benchmarks, flags risky terms and estimates potential annual upside using your volumes.
3 · We negotiate
Our team handles payer outreach and follow-up. Your staff keeps seeing patients.
4 · Verify the new fee schedule
If the payer agrees to new rates, verify the amendment and subsequent claim payments. A rate increase is not guaranteed.
What a payer contract review can uncover
Explore the contract-review examples below. A benchmark gap or opportunity score is not an executed rate increase; each practice’s outcome depends on its agreements and the payer’s response.
- Ohio92/100
Dermatopathology / Pathology Laboratory
Paraphrased review feedbackWe assumed our immunohistochemistry rates were simply what the market paid. Seeing every stain code lined up against Medicare and against an identically staffed lab in another state made it impossible for the payer to keep calling it a lab fee schedule issue.
— Pathology Lab Manager
Very High opportunity: IHC and special stains pay 39.6%–44.0% of Medicare (88342 at $44.64 vs. $101.40; 88341 at $37.87 vs. $86.81; 88312 at $39.74 vs. $100.39), w…
- Nevada90/100
Interventional Pulmonology
Paraphrased review feedbackThe procedural codes were the ones bleeding us and we could not see it. After the review, our largest bronchoscopy code nearly doubled.
— Practice Owner
Very High opportunity: 31653 moved $781 → $1,439 (+84%), 99213 moved $58 → $106 (+83%), and 31626 moved $377 → $884 (+134%).
- North Carolina88/100
Pulmonology & Sleep Medicine
Paraphrased review feedbackWe asked the Blues plan to take another look and they came back better than we thought possible. Our E&M rate moved from 120% of the 2008 Medicare baseline to 150%, and every other code landed at 140%.
— Clinic Administrator
Very High opportunity: New proposal: E&M at 150% of 2008 Medicare (current 120%, previous offer 135%); all other codes at 140% of 2008 Medicare. Contract age at re…
Get your practice benchmarked
Tell us your specialty, location and commercial billing. We start by discussing your agreements and which information is needed for a meaningful reimbursement review.
- Compare your fee schedules with available code-level benchmarks.
- Identify payer priorities and the data needed to support a rate request.
- Confidential, with no obligation to move forward.
Find out what your contracts are worth
Understand how reimbursement benchmarks work, or request a first conversation about your practice’s payer contracts.
Every review is confidential and there is no obligation to move forward.