Audit Cases 1 min read

$98,432.13 in plan savings after audit of hip replacement

Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes a sample of five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.

1. Sacramento, CA

Two-day hospital stay for right hip replacement surgery

  • Operating Room: $52,532.00
  • Implant(s): $32,750.00
  • Anesthesia: $8,430.00
  • Billed Charges: $117,566.82
  • ClaimDOC Allowed: $19,134.69
  • Plan Savings: $98,432.13
  • Reduction: 84%
High-Dollar Services: Savings Summary:

2. Salem, VA

Hospital outpatient services for surgical repair of broken leg

  • Implant(s): $40,123.00
  • Operating Room: $27,453.53
  • Medical/Surgical Supplies: $21,224.00
  • Billed Charges: $106,417.13
  • ClaimDOC Allowed: $16,383.15
  • Plan Savings: $90,033.98
  • Reduction: 85%
High-Dollar Services: Savings Summary:

3. Dothan, AL

Hospital outpatient services for gallbladder surgery

  • Medical/Surgical Supplies: $60,462.49
  • Implant(s): $18,664.22
  • Billed Charges: $99,514.33
  • ClaimDOC Allowed: $7,948.89
  • Plan Savings: $91,565.44
  • Reduction: 92%
High-Dollar Services: Savings Summary:

4. Worcester, MA

One-day hospital stay for treatment of leukemia

  • Pharmacy: $20,322.89
  • Laboratory: $19,751.00
  • CT Scans: $5,868.00
  • Billed Charges: $58,638.49
  • ClaimDOC Allowed: $13,754.30
  • Plan Savings: $44,884.19
  • Reduction: 77%
High-Dollar Services: Savings Summary:

5. Indianapolis, IN

Hospital outpatient services for treatment of leg fracture and dislocation of ankle

  • Operating Room: $27,293.10
  • Implant(s): $8,372.00
  • Emergency Department: $5,497.00
  • Billed Charges: $56,587.35
  • ClaimDOC Allowed: $9,896.81
  • Plan Savings: $46,690.54
    Reduction: 83%
High-Dollar Services: Savings Summary:

Disclaimer – The analysis of any medical billing or coding is dependent on numerous facts, regulations, payer policies, and codes, as well as the controlling plan description. The information contained herein is intended to provide a real-life example of opportunities for savings through ClaimDOC services but is not intended to provide medical, legal, or financial advice.