Audit Cases

82% bill reduction after audit of hospital outpatient services

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. Pittsburg, PA

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

  • Implants: $40,399
  • Operating Room: $18,776
  • Billed Charges: $79,831.50
  • ClaimDOC Allowed: $14,158.69
  • Plan Savings: $65,672.81
  • Reduction: 82%
High-Dollar Services: Savings Summary:

2. Hartford, CT

Fourteen-day hospital stay for the treatment of heart failure, morbid obesity and diabetes

  • Room and Board: $88,648
  • Cardiac Cath Lab: $8,421.40
  • Billed Charges: $114,871.84
  • ClaimDOC Allowed: $23,622.81
  • Plan Savings: $91,249.03
  • Reduction: 79%
High-Dollar Services: Savings Summary:

3. Kettering, OH

One-day hospital stay for the treatment of osteoarthritis of right him and related surgery

  • Operating Room: $40,287
  • Implants: $16,650.12
  • Billed Charges: $77,626.65
  • ClaimDOC Allowed: $19,766.94
  • Plan Savings: $57,859.71
  • Reduction: 74%
High-Dollar Services: Savings Summary:

4. Pittsburg, PA

Eight-day hospital stay for the treatment of malignant tumor of the uterus and related surgery

  • Operating Room: $49,808
  • Room and Board: $25,650
  • CT Scans: $17,355
  • Anesthesia: $17,255
  • Pharmacy: $15,421.75
  • Medical/Surgical Supplies: $14,544
  • Billed Charges: $163,168.75
  • ClaimDOC Allowed: $41,579.10
  • Plan Savings: $121,589.65
  • Reduction: 74%
High-Dollar Services: Savings Summary:

5. Columbus, OH

Hospital outpatient services for the treatment of atrial fibrillation

  • Cardiac Services: $73,701
  • Medical/Surgical Supplies: $22,084.50
  • Billed Charges: $101,422.70
  • ClaimDOC Allowed: $25,880.71
  • Plan Savings: $75,541.99
  • Reduction: 74%
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.