Audit Cases

86% bill reduction after audit of hospital outpatient services for spinal instabilities 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. Houston, TX

Hospital outpatient services for the treatment spinal instabilities and related surgery

High-Dollar Services:

  • Operating Room: $92,414.76

Savings Summary:

  • Billed Charges:$149,704.16
  • ClaimDOC Allowed: $20,501.15
  • Plan Savings: $129,203.01
  • Reduction: 86%

2. Macon, GA

Two-day hospital stay for the treatment of transient ischemic attack

  • CT Scans: $28,380.45
  • MRI of Brain: $9,140.25
  • Billed Charges: $54,434.23
  • ClaimDOC Allowed: $8,037.23
  • Plan Savings: $46,397.10
  • Reduction: 85%
High-Dollar Services: Savings Summary:

3. Overland Park, KS

Five-day hospital stay for the treatment of cellulitis and related surgery

  • Laboratory: $16,343.74
  • Room and Board: $12,191.50
  • Emergency Room: $10,228.82
  • Billed Charges: $63,779.91
  • ClaimDOC Allowed: $9,810.38
  • Plan Savings: $53,969.53
  • Reduction: 85%
High-Dollar Services: Savings Summary:

4. Scottsdale, AZ

Hospital outpatient services for the treatment of a right knee injury and related surgery

  • Operating Room: $134,829
  • Implants: $38,783.50
  • Billed Charges: $206,582.55
  • ClaimDOC Allowed: $33,121.50
  • Plan Savings: $173,461.05
  • Reduction: 84%
High-Dollar Services: Savings Summary:

5. Lafayette, IN

Hospital outpatient services for the treatment of heart disease and related surgery

High-Dollar Services:

  • Cath Lab: $68,226
  • Medical/Surgical Supplies: $42,007

Savings Summary:

  • Billed Charges: $124,817.68
  • ClaimDOC Allowed: $23,601.76
  • Plan Savings: $101,215.92
  • Reduction: 81%

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.