Audit Cases 1 min read

Audit of outpatient back surgery results in 91% reduction

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. Sanford, FL

Hospital outpatient setting for back surgery

  • Surgical Services: $57,764.50
  • Pharmacy: $6,046.50
  • EKG: $41,014.00
  • Billed Charges: $115,262.56
  • ClaimDOC Allowed: $10,032.56
  • Plan Savings: $105,230.38
  • Reduction: 91%
High-Dollar Services: Savings Summary:

2. Houston, TX

Five-day hospital stay due to intestinal infection

  • Laboratory Tests: $25,285.00
  • Room & Board: $17,273.00
  • Pharmacy: $14,897.00
  • Billed Charges: $85,396.00
  • ClaimDOC Allowed: $11,100.63
  • Plan Savings: $74,295.37
  • Reduction: 87%
High-Dollar Services: Savings Summary:

3. Oro Valley, AZ

Ambulatory surgical center setting for right, total hip replacement

  • Surgical Services: $85,000.00
  • Implant: $11,706.00
  • Billed Charges: $99,690.00
  • ClaimDOC Allowed: $14,877.67
  • Plan Savings: $8,4812.33
  • Reduction: 85%
High-Dollar Services: Savings Summary:

4. Charlotte, NC

Four-day hospital stay due to bleeding ulcer

  • Room & Board: $12,372.00
  • CT Scan x2: $8,679.50
  • Laboratory Tests: $9,407.45
  • Billed Charges: $479,955.51
  • ClaimDOC Allowed: $131,630.34
  • Plan Savings: $41,042.14
  • Reduction: 81%
High-Dollar Services: Savings Summary:

5. Paducah, KY

Fourteen-day hospital stay due to severe medication resistant infection

  • Nuclear Medicine Test: $52,619.20
  • Room & Board: $46,142.00
  • Surgical Services: $19,126.20
  • Laboratory Tests: $15,493.80
  • Pharmacy: $9,560.64
  • Billed Charges: $176,702.72
  • ClaimDOC Allowed: $38,834.82
  • Plan Savings: $137,867.90
  • Reduction: 78%
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.