A healthcare provider with 325 clinics nationwide found itself dealing with over 296,000 fee code variations as a result of multiple acquisitions, poor system integrations, and insufficient oversight of fee code management.
This caused a variety of issues, including:
- A highly-manual and ungoverned process for adding/removing/editing fee codes led to errors and variances, sometimes within the same clinic​
- A lack of standardized nomenclature, which led to inconsistency in training, errors, confusion, and duplication​
- Pricing was not standardized, and prices were based purely on market comparables; Costs & overhead were not factored into pricing​
- Compensation varied widely between clinicians, based on admin fees, legacy clinics, and poorly managed fee-for-service splits
Carpedia was engaged to redesign the fee code process from the ground-up and streamline the number of code iterations. This was achieved via data analysis, observations of clinical and admin staff, and interviews with all levels of the organization.
- Developed Pricing and compensation model for all codes, factoring these into clinician rate, clinic & corporate SG&A, and margins for all services using a bottom-up approach ​​
- Developed fee code dashboard to track code utilization, a removal process to flag low-utilization codes and review with clinics for removal, and trained Clinic Offices Managers on PowerBI​
- Created plan for a new fee code process, including creation of a governance committee, automation and technical enhancements, and the hiring of a fee code specialist​
- Developed fee code nomenclature for standardized, simplified, and easy to understand codes ​
- Implemented system enhancements to optimize process flow and reduce workload in admin teams​
- Conducted pricing & compensation analysis on all streams and areas to clarify variances and factors impacting pricing
The Results
- Identified ~$5.1M in revenue leakage due to incorrect pricing​
- Removed over 230,000 fee codes (approx. 725 per clinic or 81% of total)
- ~600 fewer help desk requests from clinics
