A private equity-backed ear, nose, and throat (ENT) physician practice management company (PPMC) was evaluating the acquisition of an ENT practice. Stout was engaged to perform a black-box reimbursement analysis to estimate the target practice’s collections if its services were billed under the commercial payor contracts of a practice entity affiliated with the PPMC.

To conduct the analysis, Stout repriced the target’s historical CPT codes using the affiliated entity’s payor fee schedules, covering services billed to the target practice’s top 11 commercial payors. Because the affiliated entity had more favorable commercial payor reimbursement rates, the analysis estimated that collections would increase by approximately 20% post-transaction.