Audit Cases

Audit of physician office services for chemotherapy treatment results in 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. St. Louis, MO

Physician office services for chemotherapy treatment due to malignant melanoma

High-Dollar Services:

  • Chemo IV Infusion: $566

Savings Summary:

  • Billed Charges: $82,732
  • ClaimDOC Allowed: $170.94
  • Plan Savings: $82,561.06
  • Reduction: 99%

2. Spring Valley, IL

Outpatient clinic dialysis treatments (3) for the treatment of acute kidney failure

  • Dialysis Treatments (3): $85,273.94
  • Billed Charges: $85,273.94
  • ClaimDOC Allowed: $1,275.23
  • Plan Savings: $83,998.71
  • Reduction: 99%
High-Dollar Services: Savings Summary:

3. Thibodaux, LA

Two-day hospital stay for the treatment of heart disease and related procedure

  • Cath Lab: $119,586.93
  • Medical/Surgical Supplies: $16,007.73
  • Implants: $13,562.60
  • Billed Charges: $163,281.69
  • ClaimDOC Allowed: $15,226.44
  • Plan Savings: $148,055.25
  • Reduction: 91%
High-Dollar Services: Savings Summary:

4. Chicago, IL

Hospital outpatient services for spinal stenosis and related surgery

  • Implants: $61,603
  • Operating Room: $39,075
  • Billed Charges: $132,374.11
  • ClaimDOC Allowed: $14,941.63
  • Plan Savings: $117,432.48
  • Reduction: 89%
High-Dollar Services: Savings Summary:

5. Savannah, GA

Hospital outpatient services for the treatment of uterine leiomyoma, cystocele and genital prolapse and related surgery

High-Dollar Services:

  • Operating Room: $63,717.50
  • Medical/Surgical Supplies: $28,230.50
  • Anesthesia: $25,347.30

Savings Summary:

  • Billed Charges: $148,607.33
  • ClaimDOC Allowed: $21,307.53
  • Plan Savings: $127,299.80
  • Reduction: 86%

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.