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

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: Urgent care management services organization seeks to drive revenue growth

Community Care Partners is an urgent care management services organization with 290 providers and has operations in 7 states. The group’s Chief Revenue Officer was oriented towards driving organic revenue growth, to complement its historically strong foundation in growth via M&A.

The Challenge: Widespread discrepancies between contracted rates and actual insurer payments

Community Care Partners suspected that they were leaking revenue to payers. The group 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: RevFind brings a new growth lever to the MSO’s revenue cycle team

Community Care Partners chose MD Clarity’s RevFind to systematically identify payer underpayments with contracted rates across its practices. RevFind automatically verified each incoming payment against the contracted amount. Any underpayments were consolidated into a user-friendly interface, displaying breakdowns by payer, provider, location, and CPT code. Underpayment reconciliation tasks were automatically delegated to staff to begin recovery.

The Result: $160,000 from single CPT code error recovered within 3 months

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.