Audit Cases

Audit of outpatient dialysis services for the treatment of end stage renal disease results in a 96% 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. Pueblo, CO

Outpatient dialysis services for the treatment of end stage renal disease

High-Dollar Services:

  • Dialysis Treatments (30): $137,521.88

Savings Summary:

  • Billed Charges: $137,521.88
  • ClaimDOC Allowed: $4,283.76
  • Plan Savings: $133,238.12
  • Reduction: 96%

2. Lafayette, LA

Ambulatory Surgical Center (ASC) services for the treatment of sinus polyp and deviated nasal septum

  • ASC Surgery Services: $140,728.00
  • Billed Charges: $140,728.00
  • ClaimDOC Allowed: $6,403.48
  • Plan Savings: $134,324.52
  • Reduction: 95%
High-Dollar Services: Savings Summary:

3. Gainesville, FL

Hospital outpatient services for the treatment of uterine fibroids and related surgery

  • Operating Room: $92,557.30
  • Anesthesia: $30,517.34
  • Billed Charges: $161,966.85
  • ClaimDOC Allowed: $10,571.00
  • Plan Savings: $151,395.85
  • Reduction: 93%
High-Dollar Services: Savings Summary:

4. Inverness, FL

Hospital outpatient services for the treatment of retinal detachment of left eye and related surgery

  • Operating Room: $45,322.83
  • Anesthesia: $16,108.40
  • Billed Charges: $75,020.40
  • ClaimDOC Allowed: $5,580.53
  • Plan Savings: $69,439.87
  • Reduction: 92%
High-Dollar Services: Savings Summary:

5. Harvey, IL

Hospital outpatient services for the treatment of breast cancer and chemotherapy

High-Dollar Services:

  • Pharmacy: $50,962.78

Savings Summary:

  • Billed Charges: $57,884.48
  • ClaimDOC Allowed: $4,620.54
  • Plan Savings: $53,263.94
  • Reduction: 92%

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.