Audit Cases 1 min read

Audit of umbilical and inguinal hernias repair results in a 90% 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. Blacksburg, VA

Hospital outpatient services for the surgical repair of umbilical and inguinal hernias

  • Operating Room: $46,420.00
  • Implant: $7,875.00
  • Billed Charges: $70,402.00
  • ClaimDOC Allowed: $6,824.01
  • Plan Savings: $63,577.99
  • Reduction: 90%
High-Dollar Services: Savings Summary:

2. Los Gatos, CA

Hospital outpatient services for the treatment of arthritis of left hip and related surgery

  • Implants: $51,211.12
  • Operating Room: $35,825.15
  • Medical/Surgical Supplies: $12,657.76
  • Billed Charges: $113,481.81
  • ClaimDOC Allowed: $22,640.85
  • Plan Savings: $90,840.96
  • Reduction: 80%
High-Dollar Services: Savings Summary:

3. Topeka, KS

Three-day hospital stay for the treatment of heart attack

  • Cardiac Cath Lab: $50,606.74
  • Medical/Surgical Supplies: $22,807.00
  • Billed Charges: $96,026.69
  • ClaimDOC Allowed: $19,933.55
  • Plan Savings: $76,093.14
  • Reduction: 79%
High-Dollar Services: Savings Summary:

4. Ames, IA

Two-day hospital stay for the treatment of heart attack

  • Cardiac Cath Lab: $33,953.00
  • Medical/Surgical Supplies: $7,106.14
  • Billed Charges: $51,594.34
  • ClaimDOC Allowed: $15,162.81
  • Plan Savings: $36,431.53
  • Reduction: 71%
High-Dollar Services: Savings Summary:

5. Harrisburg, PA

Hospital outpatient services for the treatment of heart atrial fibrillation

  • Cardiac Cath Lab: $47,394.00
  • Medical/Surgical Supplies: $29,571.12
  • Billed Charges: $86,276.24
  • ClaimDOC Allowed: $25,460.13
  • Plan Savings: $60,816.11
  • Reduction: 70%
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.