Audit Cases

92% claim reduction after audit of outpatient treatment of knee osteoarthritis

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. Port Charlotte, FL

Hospital outpatient services for the treatment of left knee osteoarthritis

  • Implants: $111,421.74
  • Operating Room: $75,132.79
  • Anesthesia: $13,756.19
  • Recovery Room: $11,688.80
  • Billed Charges: $237,308.23
  • ClaimDOC Allowed: $18,213.45
  • Plan Savings: $219,094.78
  • Reduction: 92%
High-Dollar Services: Savings Summary:

2. Cincinnati, OH

Eight-day hospital stay for the treatment of COVID-19 and respiratory failure

  • Room and Board: $37,106.16
  • Medical/Surgical Supplies: $14,768.67
  • Respiratory Services: $12,414.67
  • Billed Charges: $93,730.02
  • ClaimDOC Allowed: $15,200.00
  • Plan Savings: $78,530.02
  • Reduction: 84%
High-Dollar Services: Savings Summary:

3. Mason City, IA

Two-day hospital stay for the treatment of morbid obesity and diaphragmatic hernia

  • Operating Room $55,314
  • Anesthesia $10,300
  • Billed Charges: $76,944.35
  • ClaimDOC Allowed: $20,496.65
  • Plan Savings: $56,447.70
  • Reduction: 73%
High-Dollar Services: Savings Summary:

4. Waterbury, CT

Four-day hospital stay for the treatment of coronary artery disease

  • Operating Room: $38,653.00
  • Room and Board: $27,354.36
  • Anesthesia: $11,970.00
  • Billed Charges: $122,649.37
  • ClaimDOC Allowed: $38,909.21
  • Plan Savings: $83,740.16
  • Reduction: 68%
High-Dollar Services: Savings Summary:

5. Boston, MA

Twenty-two-day hospital stay for the treatment of leukemia and bone marrow transplant

  • Room and Board: $103,840.00
  • Organ Acquisition: $87,775.00
  • Blood Storage/Processing: $65,614.00
  • Laboratory: $32,350.00
  • Pharmacy: $27,450.00
  • Billed Charges: $356,268.25
  • ClaimDOC Allowed: $135,719.25
  • Plan Savings: $220,549.00
  • Reduction: 62%
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.