Audit Cases

Audit of outpatient services for dialysis treatments result 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 services for the treatment of end-stage renal disease and three-day dialysis treatments

  • Dialysis Treatments (3): $67,951.25
  • Billed Charges: $67,951.25
  • ClaimDOC Allowed: $925.44
  • Plan Savings: $67,025.81
  • Reduction: 98%
High-Dollar Services: Savings Summary:

2. Des Moines, IA

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

  • Room and Board: $21,340
  • Pharmacy: $18,418
  • Laboratory: $13,164.19
  • CT Scans: $10,589.68
  • Billed Charges: $106,966.18
  • ClaimDOC Allowed: $20,691.93
  • Plan Savings: $86,274.25
  • Reduction: 80%
High-Dollar Services: Savings Summary:

3. Houston, TX

Hospital outpatient services for the treatment of hemoglobinuria

  • Pharmacy: $454,039.51
  • Billed Charges: $456,517.51
  • ClaimDOC Allowed: $101,889.35
  • Plan Savings: $354,628.16
  • Reduction: 77%
High-Dollar Services: Savings Summary:

4. Worchester, MA

Hospital outpatient services for the treatment of malignant neoplasm of left upper arm/shoulder

  • Pharmacy: $103,862.91
  • Billed Charges: $106,017.91
  • ClaimDOC Allowed: $26,297.47
  • Plan Savings: $79,720.44
  • Reduction: 75%
High-Dollar Services: Savings Summary:

5. Freeport, IL

Two-day hospital stay for the treatment of hernia and related surgery

High-Dollar Services:

  • Operating Room: $17,983
  • Medical/Surgical Supplies: $15,492
  • Pharmacy: $9,427.87

Savings Summary:

  • Billed Charges: $54,317.40
  • ClaimDOC Allowed: $14,028.55
  • Plan Savings: $40,288.85
  • 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.