Community Care Partners Recovers $160,000 from Single CPT Code within 3 Months

The Summary

Community Care Partners implemented MD Clarity’s RevFind to achieve:

  • $160,000 in immediate underpayment recovery from one CPT code
  • Positive ROI within 3 Months
  • $80,000 additional recovery, plus ongoing revenue uplift

The Situation

Community Care Partners is an urgent care management services organization with 290 providers and has operations in 7 states.

The Challenge

Community Care Partners did not know whether the actual payments coming in from payers matched contracted rates. They had little insight into which payers and CPT codes were triggering underpayments. They struggled with:

  • Difficulty identifying high-opportunity underpayments at scale
  • Cumbersome, manual contract management processes

The Solution

Community Care Partners chose MD Clarity’s RevFind to systematically identify payer underpayments with contracted rates across its practices.

The Results

RevFind quickly found several payers underpaying on multiple CPT codes. The first recovery from one CPT code from one payer amounted to $160,000 and was recovered within 3 months of go-live.

RevFind identified two CPT codes from one payer that were being reimbursed just $5 below contracted rates. The payer agreed to reimburse $80,000 after reprocessing the tens of thousands of claims impacted by this clerical error. The clerical error has been fixed, so Community Care Partners is also realizing an ongoing revenue uplift from this RevFind-driven correction.

Get paid in full by bringing clarity to your revenue cycle