Audit Cases

Audit of ASC services for treatment of neck and back pain and related surgery results in a 99% 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. Coppell, TX

ASC services for the treatment of neck and back pain and related surgery

High-Dollar Services:

  • ASC Surgery: $116,929.67

Savings Summary:

  • Billed Charges: $116,929.67
  • ClaimDOC Allowed:  $1,057.14
  • Plan Savings: $115,872.53
  • Reduction: 99%

2. Old Lyme, CT

Physician services for the treatment of breast cancer and related surgery

  • Physician Services: $59,390
  • Billed Charges: $50,390 
  • ClaimDOC Allowed: $1,950.45 
  • Plan Savings: $48,439.55
  • Reduction: 96%
High-Dollar Services: Savings Summary:

3. Tallahassee, FL

Hospital outpatient services for the treatment of cervical cancer with radiation treatments

  • Radiation Therapy Treatments (26): $230,652.26
  • Billed Charges: $230,652.26
  • ClaimDOC Allowed: $26,297.23
  • Plan Savings: $204,355.03
  • Reduction: 89%
High-Dollar Services: Savings Summary:

4. New Haven, CT

Five-day hospital stay for treatment of aplastic anemia with chemotherapy

  • Pharmacy: $397,080.83
  • Billed Charges: $452,960.46
  • ClaimDOC Allowed: $67,041
  • Plan Savings: $385,919.46
  • Reduction: 85%
High-Dollar Services: Savings Summary:

5. Columbus, OH

Hospital outpatient services for the treatment of breast cancer and related surgery

High-Dollar Services:

  • Skin Allograft: $85,400
  • Operating Room: $70,000.02

Savings Summary:

  • Billed Charges: $188,218.71
  • ClaimDOC Allowed: $48,575.85
  • Plan Savings: $139,642.86
  • 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.