Audit Cases 1 min read

Audit of outpatient surgery results in an 84% 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. Nashville, TN

Hospital outpatient services for the treatment of uterovaginal prolapse and related surgery

  • Operating Room: $45,274.02
  • Recovery Room: $14,859
  • Anesthesia: $10,280
  • Billed Charges: $78,849.45
  • ClaimDOC Allowed: $12,947.56
  • Plan Savings: $65,901.89
  • Reduction: 84%
High-Dollar Services: Savings Summary:

2. Atlanta, GA

Nine-day hospital stay for the treatment of spleen laceration and fractures of foot and toes

  • Operating Room: $76,152
  • Room and Board: $39,108
  • CT Scans: $37,025
  • Radiology: $18,586
  • Billed Charges: $228,930.27
  • ClaimDOC Allowed: $46,902.38
  • Plan Savings: $182,027.89
  • Reduction: 80%
High-Dollar Services: Savings Summary:

3. Peoria, IL

Five-day hospital stay for the treatment of sepsis and acute respiratory failure

  • Room and Board: $21,728
  • Laboratory: $14,091.65
  • Billed Charges: $74,330.75
  • ClaimDOC Allowed: $15,872.68
  • Plan Savings: $58,458.07
  • Reduction: 79%
High-Dollar Services: Savings Summary:

4. Miamisburg, OH

Eight-day hospital stay for the treatment of acute respiratory failure and pneumonia

  • Respiratory Therapy: $39,678.05
  • Room and Board: $38,384
  • Pharmacy: $25,078.91
  • Billed Charges: $127,217.37
  • ClaimDOC Allowed: $29,427.36
  • Plan Savings: $97,790.01
  • Reduction: 77%
High-Dollar Services: Savings Summary:

5. Denver, CO

Six-day hospital stay for the treatment of rheumatic disorders of mitral and tricuspid valves

  • Implants: $52,622.10
  • Operating Room: $43,516.30
  • Medical/Surgical Supplies: $33,589.28
  • Room and Board: $32,247.85
  • Laboratory: $24,030.80
  • Billed Charges: $214,648.90
  • ClaimDOC Allowed: $53,334.71
  • Plan Savings: $161,314.19
  • Reduction: 75%
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.