Audit Cases

Audit of left arm humerus fracture 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. West Palm Beach, FL

Hospital outpatient services for the treatment of left arm humerus fracture

High-Dollar Services:

  • Operating Room: $77,733
  • Implants: $37,724

Savings Summary:

  • Billed Charges: $156,718
  • ClaimDOC Allowed: $15,186.96 
  • Plan Savings: $141,531.04
  • Reduction: 90%

2. La Jolla, CA

One-day hospital stay for the treatment of prostate cancer and related surgery

  • Operating Room: $118,200
  • Laboratory: $28,489
  • Billed Charges: $182,247.09
  • ClaimDOC Allowed: $25,981.50
  • Plan Savings: $156,265.59
  • Reduction: 86%
High-Dollar Services: Savings Summary:

3. Columbus, IN

Ambulatory Surgical Center (ASC) services for the treatment of osteoarthritis of right knee/surgery

  • Surgery with Implant: $73,341
  • Billed Charges: $73,341
  • ClaimDOC Allowed: $11,534.64
  • Plan Savings: $61,806.36
  • Reduction: 84%
High-Dollar Services: Savings Summary:

4. Rock Hall, SC

Seven-day hospital stay for the treatment of cellulitis of right lower leg, diabetes and morbid obesity

  • Room and Board: $20,096
  • Laboratory: $13,780
  • Billed Charges: $84,403
  • ClaimDOC Allowed: $15,679.60
  • Plan Savings: $68,723.40
  • Reduction: 81%
High-Dollar Services: Savings Summary:

5. New York, NY

Three-day hospital stay for the treatment of scoliosis and related surgery

High-Dollar Services:

  • Implants: $254,039.70
  • Operating Room: $76,122
  • Diagnostic Services: $26,915
  • Medical/Surgical Supplies: $12,271.13

Savings Summary:

  • Billed Charges: $412,827.27
  • ClaimDOC Allowed: $94,026.05 
  • Plan Savings: $318,801.22
  • 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.