Audit Cases

Audit of five-day hospital stay for treatment of sepsis results in 89% 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. Turlock, CA

Five-day hospital stay for treatment of sepsis

High-Dollar Services:

  • Operating Room: $56,268
  • Laboratory: $24,082.83
  • Room and Board: $17,524

Savings Summary:

  • Billed Charges: $196,060.83
  • ClaimDOC Allowed: $22,111.80
  • Plan Savings: $173,949.03
  • Reduction: 89%

2. Fayetteville, GA

Hospital outpatient services for the treatment of cancer of pelvic tissue and radiation treatments (13)

  • Radiation Treatments (13): $94,991
  • Radiotherapy Dose Planning: $12,303
  • Billed Charges: $120,150
  • ClaimDOC Allowed: $14,903.22
  • Plan Savings: $105,246.78
  • Reduction: 88%
High-Dollar Services: Savings Summary:

3. Orlando, FL

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

  • Operating Room: $18,743
  • Room and Board: $16,010
  • MRIs: $12,269
  • CT Scan: $12,201
  • Billed Charges: $83,197.37
  • ClaimDOC Allowed: $11,850.54
  • Plan Savings: $171,346.83
  • Reduction: 86%
High-Dollar Services: Savings Summary:

4. Saratoga Springs, NY

Hospital outpatient services for the treatment of atrial fibrillation and related procedure

  • Cardiac Cath Lab: $32,794
  • Implant: $24,286
  • Billed Charges: $77,860.81
  • ClaimDOC Allowed: $11,635.50
  • Plan Savings: $66,225.31
  • Reduction: 85%
High-Dollar Services: Savings Summary:

5. Mason City, IA 

Hospital outpatient services for the treatment of testicular cancer and chemotherapy

High-Dollar Services:

  • Pharmacy: $23,851.35
  • IV Infusions: $30,242

Savings Summary:

  • Billed Charges: $65,211
  • ClaimDOC Allowed: $10,283.35
  • Plan Savings: $54,927.65
  • Reduction: 84%

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.