Audit Cases

Audit of outpatient for knee dislocation results in an 81% 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. Raleigh, NC

Hospital outpatient services for the treatment of dislocation of the left knee

  • Operating Room: $17,562
  • Medical/Surgical Supplies: $16,843.16
  • Implant: $12,176.25
  • Billed Charges: $57,624.30
  • ClaimDOC Allowed: $11,096.73
  • Plan Savings: $46,527.57
  • Reduction: 81%
High-Dollar Services: Savings Summary:

2. Morristown, NJ

Six-day hospital stay for the treatment of diverticulitis of the small intestine and perforation

  • Room and Board: $42,312
  • Operating Room: $11,286
  • Medical/Surgical Supplies: $10,087.57
  • Billed Charges: $88,248.30
  • ClaimDOC Allowed: $28,678.03
  • Plan Savings: $59,570.27
  • Reduction: 68%
High-Dollar Services: Savings Summary:

3. Mason City, IA

Twelve-day hospital stay for the treatment of heart attack, shock, respiratory and kidney failure

  • Operating Room-General: $130,914
  • Pharmacy: $123,439.50
  • Room and Board: $84,292
  • Pacemaker $30,058
  • Operating R:oom – Minor: $29,906
  • Recovery Room: $21,894
  • Billed Charges: $621,809.15
  • ClaimDOC Allowed: $224,158.31
  • Plan Savings: $397,650.84
  • Reduction: 64%
High-Dollar Services: Savings Summary:

4. Edina, MN

Six-day hospital stay for the treatment of diabetes and cellulitis of the right leg

  • Room and Board: $25,386
  • Laboratory: $5,899
  • Pharmacy: $5,851.60
  • Billed Charges: $53,906.28
  • ClaimDOC Allowed: $19,829.08
  • Plan Savings: $34,077.20
  • Reduction: 63%
High-Dollar Services: Savings Summary:

5. Hartford, CT

Thirty-day hospital stay for the treatment of COVID-19, sepsis, pneumonia, and renal disease

  • Room and Board: $175,183
  • Laboratory: $37,678.12
  • CT Scans: $34,294.85
  • Pharmacy: $29,713.03
  • MRIs: $19,771.20
  • Billed Charges: $368,407.49
  • ClaimDOC Allowed: $143,074.64
  • Plan Savings: $225,332.85
  • Reduction: 61%
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.