Audit Cases

Audit of outpatient dialysis treatments results in 98% bill 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. East Hartford, CT

Outpatient dialysis treatments (3) for end-stage renal disease

  • Dialysis Treatments (3): $67,951.25
  • Billed Charges: $71,130.10
  • ClaimDOC Allowed: $955.73
  • Plan Savings: $70,174.37
  • Reduction: 98%
High-Dollar Services: Savings Summary:

2. Oviedo, FL

Hospital outpatient services for the treatment of excessive menstruation and related surgery

  • Operating Room: $68,046.25
  • Anesthesia: $26,369.50
  • Billed Charges: $110,345.34
  • ClaimDOC Allowed: $10,428.33
  • Plan Savings: $99,917.01
  • Reduction: 90%
High-Dollar Services: Savings Summary:

3. Stockburger, GA

Three-day hospital stay for the treatment of gallstones and related surgery

  • Operating Room: $17,764
  • GI Services: $15,389
  • Billed Charges: $66,969.05
  • ClaimDOC Allowed: $13,481.65
  • Plan Savings: $53,487.40
  • Reduction: 79%
High-Dollar Services: Savings Summary:

4. Kettering, OH

Twelve-day hospital stay for the treatment of multiple fractures due to motorcycle injury

  • Operating Room: $212,123
  • Room and Board: $87,824
  • Implants: $65,805
  • Blood: $11,649
  • Medical/Surgical Supplies: $11,197
  • Billed Charges: $538,059.46
  • ClaimDOC Allowed: $121,405
  • Plan Savings: $416,654.46
  • Reduction: 77%
High-Dollar Services: Savings Summary:

5. Brewer, ME

Five-day hospital stay for the treatment of heart disease

High-Dollar Services:

  • Operating Room: $46,724
  • Room and Board: $20,910
  • Pharmacy: $14,038.58

Savings Summary:

  • Billed Charges: $140,894.58
  • ClaimDOC Allowed: $36,590.91
  • Plan Savings: $104,303.67
  • Reduction: 74%

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.