Audit Cases

Audit of treatment of convulsions leads to an 88% claim 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. Cleveland, OH

Six-day hospital stay for treatment of convulsions

  • EEGs: $53,444.00
  • ICU Room and Board: $20,376.00
  • Billed Charges: $79,365.15
  • ClaimDOC Allowed: $9,813.01
  • Plan Savings: $69,552.14
  • Reduction: 88%
High-Dollar Services: Savings Summary:

2. Fairfield, CA

Three-day hospital stay for delivery of newborn by c-section

  • Operating Room: $41,996.41
  • Room and Board: $17,711.88
  • Pharmacy: $13,633.30
  • Billed Charges: $96,684.88
  • ClaimDOC Allowed: $12,064.66
  • Plan Savings: $84,620.22
  • Reduction: 87%
High-Dollar Services: Savings Summary:

3. Salem, VA

Two-day hospital stay for gallbladder surgery due to gallstones

  • Operating Room: $45,129.00
  • Medical/Surgical Supplies: $29,573.00
  • Billed Charges: $115,913.50
  • ClaimDOC Allowed: $18,591.85
  • Plan Savings: $97,321.65
  • Reduction: 84%
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. Fort Meyers, FL

Four-day hospital stay for treatment of heart attack

  • 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: $25,031.95
  • Plan Savings: $67,883.85
  • Reduction: 73%
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.