Audit Cases

86% bill reduction after audit of outpatient services for treatment of leiomyoma of the uterus

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. Salem, VA

Hospital outpatient services for the treatment of leiomyoma of the uterus

High-Dollar Services:

  • Operating Room: $41,685
  • Medical/Surgical Supplies: $12,971
  • Recovery Room: $9,305

Savings Summary:

  • Billed Charges: $75,907
  • ClaimDOC Allowed: $10,290.80
  • Plan Savings: $65,616.20
  • Reduction: 86%

2. Atlanta, GA

Hospital outpatient services for the treatment of retinal detachment

  • Operating Room: $27,676
  • Medical/Surgical Supplies: $9,727.04
  • Recovery Room: $7,803
  • Billed Charges: $55,649.96
  • ClaimDOC Allowed: $9,298.80
  • Plan Savings: $46,351.16
  • Reduction: 83%
High-Dollar Services: Savings Summary:

3. Winter Haven, FL

One-day hospital stay for treatment of heart disease, morbid obesity, and diabetes

  • Cardiac Cath Lab: $21,339
  • Nuclear Medicine: $7,810
  • Billed Charges: $56,823.49
  • ClaimDOC Allowed: $9,924.39
  • Plan Savings: $46,899.10
  • Reduction: 82%
High-Dollar Services: Savings Summary:

4. Madison, WI

Two-day hospital stay for the treatment of heart attack and breakdown of heart valve

  • Cardiac Cath Lab: $18,066
  • Cardiology Services: $12,594
  • Billed Charges: $416,730.84
  • ClaimDOC Allowed: $108,138.91
  • Plan Savings: $308,591.93
  • Reduction: 74%
High-Dollar Services: Savings Summary:

5. Winston Salem, NC 

Eleven-day hospital stay for the treatment of heart attack and complications of a heart valve implant

High-Dollar Services:

  • Operating Room: $88,503
  • Anesthesia: $64,304
  • Pacemaker: $40,615.88
  • Medical/Surgical Supplies: $39,033.14
  • Pharmacy: $35,822.40
  • Implants: $35,615.55
  • Laboratory: $23,945.37
  • Room and Board: $22,744
  • Echocardiology: $13,520

Savings Summary:

  • Billed Charges: $416,730.84
  • ClaimDOC Allowed: $108,138.91
  • Plan Savings: $308,591.93
  • 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.