Audit Cases

Audit of outpatient appendicitis treatment and surgery results in 92% 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. Los Angeles, CA

Hospital outpatient services for the treatment of appendicitis with perforation and related surgery

  • Operating Room: $30,607
  • CT Scan: $29,673
  • Emergency Room: $9,427
  • Billed Charges: $99,787
  • ClaimDOC Allowed: $7,976.14
  • Plan Savings: $91,810.86
  • Reduction: 92%
High-Dollar Services: Savings Summary:

2. Manhasset, NY

Hospital outpatient services for the treatment of ventral hernia and related surgery

  • Operating Room: $40,205
  • Anesthesia: $7,010
  • Billed Charges: $59,909
  • ClaimDOC Allowed: $8,779.77
  • Plan Savings: $51,129.23
  • Reduction: 85%
High-Dollar Services: Savings Summary:

3. Tyler, TX

One-day hospital stay for the treatment of heart attack

  • Cath Lab: $75,912
  • Implants: $9,416
  • Billed Charges: $108,582.75
  • ClaimDOC Allowed: $16,541.21
  • Plan Savings: $92,041.54
  • Reduction: 84%
High-Dollar Services: Savings Summary:

4. Worchester, MA

Outpatient hospital services for the treatment of brain and lung cancer

  • Pharmacy: $99,379
  • Billed Charges: $102,472
  • ClaimDOC Allowed: $18,443.92
  • Plan Savings: $84,028.08
  • Reduction: 82%
High-Dollar Services: Savings Summary:

5. Des Moines, IA

Fourteen-day hospital stay for the treatment of abdominal cancer

High-Dollar Services:

  • Room and Board: $32,496
  • Laboratory: $28,479
  • Operating Room: $21,144
  • CT Scans: $13,069
  • MRI: $11,727
  • Treatment Room: $10,455

Savings Summary:

  • Billed Charges: $134,449.27
  • ClaimDOC Allowed: $26,974.05
  • Plan Savings: $107,475.22
  • Reduction: 79%

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.