Audit Cases

Audit of outpatient services for treatment of rib fractures results in 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. Austin, TX

Hospital outpatient services for the treatment of rib fractures and fracture of mandible

High-Dollar Services:

  • Trauma Level 2 Care: $35,178
  • CT Scan: $7,283

Savings Summary:

  • Billed Charges:$61,601
  • ClaimDOC Allowed: $2,216.82
  • Plan Savings: $59,384.18
  • Reduction: 96%

2. Independence, MO

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

  • Operating Room: $28,022.12
  • CT Scan: $16,361
  • Billed Charges: $62,173.77
  • ClaimDOC Allowed: $6,108.04
  • Plan Savings: $56,065.73
  • Reduction: 90%
High-Dollar Services: Savings Summary:

3. Aurora, CO

Ten-day hospital stay for the treatment of hypertension and congestive heart failure

  • Room and Board: $68,267.30
  • Laboratory: $27,462.11
  • Cardiology: $13,584.76
  • Billed Charges: $151,849.21
  • ClaimDOC Allowed: $24,870.56
  • Plan Savings: $126,978.65
  • Reduction: 84%
High-Dollar Services: Savings Summary:

4. Tampa, FL

Eight-day hospital stay for the treatment of endocrine disorder

  • Laboratory: $39,399.61
  • Room and Board: $23,115
  • Billed Charges: $109,438.66
  • ClaimDOC Allowed: $23,544.71
  • Plan Savings: $85,893.95
  • Reduction: 78%
High-Dollar Services: Savings Summary:

5. Louisville, KY

Nine-day hospital stay for the treatment of spinal cord injury and related surgery

High-Dollar Services:

  • Implants: $104,853
  • Operating Room: $44,966
  • Room and Board: $20,016

Savings Summary:

  • Billed Charges: $257,319.62
  • ClaimDOC Allowed: $71,361.59
  • Plan Savings: $185,958.03
  • Reduction: 72%

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.