Audit Cases

Audit of osteoarthritis treatment results in 90% 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. Sarasota, FL

Outpatient ASC services for the treatment of osteoarthritis of left hip and related surgery.

High-Dollar Services:

  • Ambulatory Surgical Center Services: $118,425.75

Savings Summary:

  • Billed Charges: $118,425.75
  • ClaimDOC Allowed: $11,193.50
  • Plan Savings: $107,232.25
  • Reduction: 90%

2. Norwich, CT

Outpatient ASC services for breast reconstruction due to cancer.

  • Ambulatory Surgical Center Services: $53,490
  • Billed Charges: $53,490
  • ClaimDOC Allowed: $5,649.78
  • Plan Savings: $47,840.22
  • Reduction: 89%
High-Dollar Services: Savings Summary:

3. Jacksonville, FL

Hospital outpatient services for the treatment of blood vessel disorder and anemia.

  • Minor Treatment Room: $57,421.50
  • Billed Charges: $62,319.46
  • ClaimDOC Allowed: $10,971.14
  • Plan Savings: $51,348.32
  • Reduction: 82%
High-Dollar Services: Savings Summary:

4. Beachwood, OH

One-day hospital stay for the treatment of heart attack.

  • Cath Lab: $61,493
  • Billed Charges: $78,296.69
  • ClaimDOC Allowed: $17,297.80
  • Plan Savings: $60,998.89
  • Reduction: 78%
High-Dollar Services: Savings Summary:

5. Roslyn, NY

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

High-Dollar Services:

  • Operating Room: $19,890
    Pharmacy: $18,484

Savings Summary:

  • Billed Charges: $60,396.56
  • ClaimDOC Allowed: $13,867.21
  • Plan Savings: $46,529.35
  • Reduction: 77%

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.