Audit Cases

95% bill reduction after audit of ASC services for treatment of spinal stenosis and back pain

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. Savannah, GA

Ambulatory surgical center services for the treatment spinal stenosis and back pain

High-Dollar Services:

  • Operating Room: $153,956.92
  • Implants: $33,244.96

Savings Summary:

  • Billed Charges: $189,499.98
  • ClaimDOC Allowed: $10,594.74
  • Plan Savings: $178,905.24
  • Reduction: 95%

2. Wichita, KS

Outpatient hospital services for the treatment of dizziness and nausea

  • CT Scans: $32,833
  • MRI Brain: $12,882
  • Billed Charges: $83,514.38
  • ClaimDOC Allowed: $4,820.62
  • Plan Savings: $78,693.76
  • Reduction: 95%
High-Dollar Services: Savings Summary:

3. Macon, GA

Ambulatory surgical center services for breast reconstruction due to breast cancer

  • Operating Room: $79,328.69
  • Billed Charges: $81,414.29
  • ClaimDOC Allowed: $7,085.47
  • Plan Savings: $74,328.82
  • Reduction: 92%
High-Dollar Services: Savings Summary:

4. Denville, NJ

Two-day hospital stay for the treatment of atherosclerosis of left leg and related surgery

  • Operating Room: $151,462.50
  • Medical/Surgical Supplies: $26,375.86
  • Billed Charges: $234,953.78
  • ClaimDOC Allowed: $36,951.61
  • Plan Savings: $198,002.17
  • Reduction: 85%
High-Dollar Services: Savings Summary:

5. Smithtown, NY

One-day hospital stay for the treatment of abdominal aortic aneurysm and related surgery

High-Dollar Services:

  • Implants: $102,321.25
  • Operating Room: $56,604

Savings Summary:

  • Billed Charges: $190,976.23
  • ClaimDOC Allowed: $43,275.81
  • Plan Savings: $147,700.42
  • Reduction: 78%

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.