Audit Cases

Audit of outpatient hospital services for hemorrhoid treatment results in 95% 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. San Antonio, TX

Outpatient hospital services for the treatment of hemorrhoids and related surgery

High-Dollar Services:

  • Operating Room: $33,056
  • Recovery Room: $21,260

Savings Summary:

  • Billed Charges: $65,569
  • ClaimDOC Allowed: $3,036.41
  • Plan Savings: $62,532.59
  • Reduction: 95%

2. Wichita, KS

Outpatient hospital services for the treatment of a kidney stone and related surgery

  • Lithotripsy: $73,529
  • Billed Charges: $110,048
  • ClaimDOC Allowed: $8,086.21
  • Plan Savings: $101,961.79
  • Reduction: 93%
High-Dollar Services: Savings Summary:

3. Tyler, TX

Outpatient hospital services for the treatment of uterine leiomyoma and related surgery

  • Operating Room: $70,094
  • Billed Charges: $89,418.66
  • ClaimDOC Allowed: $10,426.09
  • Plan Savings: $78,992.57
  • Reduction: 88%
High-Dollar Services: Savings Summary:

4. Huntington, WV

Outpatient hospital services for the treatment of breast cancer with chemotherapy

  • Pharmacy: $49,008.90
  • Billed Charges: $60,059.40
  • ClaimDOC Allowed: $8,155.32
  • Plan Savings: $51,904.08
  • Reduction: 86%
High-Dollar Services: Savings Summary:

5. Tallahassee, FL

Hospital outpatient treatment of toe deformities of the right foot and related surgery

High-Dollar Services:

  • Operating Room: $35,588.65
  • Implants: $21,248

Savings Summary:

  • Billed Charges: $84,039.50
  • ClaimDOC Allowed: $12,994.22
  • Plan Savings: $71,045.28
  • Reduction: 85%

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.