Audit Cases

Audit of outpatient hospital services for neck pain 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. Coppell, TX

Outpatient hospital services for the treatment of neck pain and osteoarthritis of the spine

High-Dollar Services:

  • Surgery: $59,567.75

Savings Summary:

  • Billed Charges: $59,567.75
  • ClaimDOC Allowed: $524.44
  • Plan Savings: $59,043.31
  • Reduction: 99%

2. Cleveland, OH

Outpatient clinic dialysis (10) for the treatment of end stage renal disease

  • Dialysis Treatments (10): $137,521.11
  • Billed Charges: $137,521.11
  • ClaimDOC Allowed: $3,197.40
  • Plan Savings: $134,323.71
  • Reduction: 98%
High-Dollar Services: Savings Summary:

3. Port Charlotte, FL

ASC surgery for the treatment of multiple subcutaneous masses

  • Surgery: $74,870
  • Billed Charges: $74,870
  • ClaimDOC Allowed: $3,857.83
  • Plan Savings: $71,012.17
  • Reduction: 95%
High-Dollar Services: Savings Summary:

4. Las Vegas, NV

ASC surgery for the treatment of right wrist ligament tear and ganglion

  • Surgery: $69,455
  • Billed Charges: $69,455
  • ClaimDOC Allowed: $6,965.66
  • Plan Savings: $62,489.34
  • Reduction: 90%
High-Dollar Services: Savings Summary:

5. Huntington, WV

Four-day hospital stay for the treatment of diverticulitis and attention to colostomy

High-Dollar Services:

  • Implants: $81,163
  • Operating Room: $23,140

Savings Summary:

  • Billed Charges: $146,379.54
  • ClaimDOC Allowed: $26,313.53
  • Plan Savings: $120,066.01
  • Reduction: 82%

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.