Audit Cases

93% bill reduction after audit of ASC services for endometriosis

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. Statesboro, GA

Ambulatory surgical center services for the treatment of uterine endometriosis, adhesions, and infertility

High-Dollar Services:

  • Surgery: $70,169.75

Savings Summary:

  • Billed Charges: $70,169.75
  • ClaimDOC Allowed: $5,091.01
  • Plan Savings: $65,078.74
  • Reduction: 93%

2. Plant City, FL

Hospital outpatient treatment for knee sprain and related surgery

  • Operating Room: $81,491.08
  • Medical/Surgical Supplies: $10,503.76
  • Billed Charges: $127,757.56
  • ClaimDOC Allowed: $13,099.16
  • Plan Savings: $114,658.40
  • Reduction: 90%
High-Dollar Services: Savings Summary:

3. Manteca, CA

Outpatient hospital services for the treatment of bilateral inguinal hernias and related surgery

  • Operating Room: $70,193
  • Anesthesia: $12,313
  • Billed Charges: $103,522.32
  • ClaimDOC Allowed: $11,232.52
  • Plan Savings: $92,289.80
  • Reduction: 89%
High-Dollar Services: Savings Summary:

4. Kansas City, KS

Eight-day hospital stay for the treatment of brain bleed and related surgery

  • Pharmacy: $42,935.59
  • CT Scans: $33,730
  • Operating Room: $28,912
  • Laboratory: $22,072
  • Billed Charges: $258,406.50
  • ClaimDOC Allowed: $54,313.08
  • Plan Savings: $204,093.42
  • Reduction: 79%
High-Dollar Services: Savings Summary:

5. Albany, NY

Twelve-day hospital stay for the treatment of heart disease and related surgery

High-Dollar Services:

  • Operating Room: $56,123
  • Room and Board: $51,251
  • Medical/Surgical Supplies: $48,730.51

Savings Summary:

  • Billed Charges: $290,383.71
  • ClaimDOC Allowed: $91,580.50
  • Plan Savings: $198,803.21
  • Reduction: 68%

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.