Audit Cases

99% bill reduction after audit of breast cancer treatment

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. Bridgeport, CT

Assistant surgeon services for the treatment of breast cancer and related surgery

High-Dollar Services:

  • Assistant Surgeon Services: $80,640

Savings Summary:

  • Billed Charges: $80,640
  • ClaimDOC Allowed: $237
  • Plan Savings: $80,403
  • Reduction: 99%

2. San Ramon, CA

Ambulatory Surgical Center services for the treatment of medial meniscus tear, left knee

  • Ambulatory Surgery Center Services: $60,600
  • Billed Charges: $60,600
  • ClaimDOC Allowed: $2,319.04
  • Plan Savings: $58,280.96
  • Reduction: 96%
High-Dollar Services: Savings Summary:

3. Maysville, KY

Outpatient dialysis services for the treatment of end-stage renal disease (13 treatments)

  • Dialysis Treatments (13): $105,469
  • Billed Charges: $105,469
  • ClaimDOC Allowed: $4,128.15
  • Plan Savings: $101,340.85
  • Reduction: 96%
High-Dollar Services: Savings Summary:

4. Austin, TX

Hospital outpatient services for the treatment of ovarian cyst and related surgery

  • Medical/Surgical Supplies $19,169
  • Operating Room $15,974
  • CT abdomen/pelvis $14,366.10
  • Billed Charges: $73,266.30
  • ClaimDOC Allowed: $6,189.09
  • Plan Savings: $67,077.21
  • Reduction: 91%
High-Dollar Services: Savings Summary:

5. Gainesville, FL 

Six-day hospital stay for the delivery of newborn with complications

High-Dollar Services:

  • Operating Room $21,654.33
    Room and Board $14,238.15

Savings Summary:

  • Billed Charges: $66,615.86
  • ClaimDOC Allowed: $9,318.25
  • Plan Savings: $57,297.61
  • Reduction: 86%

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.