Audit Cases 1 min read

Audit of injuries from car collision leads to major plan savings

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. Bridgeport, CT

Twenty-day hospital stay for treatment multiple fractures resulting from a car collision

  • Medical/Surgical Supplies: $168,434.00
  • Room and Board ICU/Surg: $115,336.00
  • Operating Room: $79,466.00
  • Laboratory Services: $24,570.00
  • Anesthesia: $12,162.00
  • Billed Charges: $451,840.99
  • ClaimDOC Allowed: $167,303.72
  • Plan Savings: $284,537.27
  • Reduction: 63%
High-Dollar Services: Savings Summary:

2. Henderson, NC

Three-day hospital stay for treatment of respiratory failure

  • Pharmacy: $12,608.70
  • Respiratory Services: $8,636.76
  • Emergency Room: $6,383.23
  • Laboratory Services: $6,194.70
  • Billed Charges: $50,741.75
  • ClaimDOC Allowed: $19,897.71
  • Plan Savings: $30,844.04
  • Reduction: 61%
High-Dollar Services: Savings Summary:

3. Mount Vernon, OH

Two-day hospital stay for treatment of blood clot due to implanted device

  • Medical/Surgical Supplies: $66,239.25
  • Cardiac Cath Lab: $32,947.98
  • Operating Room: $17,228.96
  • Billed Charges: $127,121.91
  • ClaimDOC Allowed: $42,245.57
  • Plan Savings: $84,876.34
  • Reduction: 67%
High-Dollar Services: Savings Summary:

4. Victoria, TX

Nine-day hospital stay for treatment of heart attack and pneumonia

  • Cardiac Cath Lab: $57,018.00
  • Pharmacy: $30,543.90
  • Respiratory Services: $27,609.00
  • Room and Board ICU/CCU: $13,390.00
  • Billed Charges: $152,189.40
  • ClaimDOC Allowed: $38,556.26
  • Plan Savings: $113,633.14
  • Reduction: 75%
High-Dollar Services: Savings Summary:

5. Charleston, WV

Ten-day hospital stay for cardiac surgery due to heart disease

  • Operating Room: $128,772.00
  • Room and Board ICU/CCU: $36,786.00
  • Cardiac Cath Lab: $11,897.00
  • Billed Charges: $217,139.54
  • ClaimDOC Allowed: $60,344.74
  • Plan Savings: $156,794.80
  • Reduction: 72.21%
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.