Audit Cases

Audit of spondylosis and myalgia 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

ASC services for the treatment of spondylosis, myalgia and related surgery

High-Dollar Services:

  • Surgery: $42,778.40
  • Radiology: $13,595.40

Savings Summary:

  • Billed Charges: $124,237.44
  • ClaimDOC Allowed: $1,091.62
  • Plan Savings: $123,145.82
  • Reduction: 99%

2. Aurora, CO

Three-day hospital stay for mediastinum disease and related surgery

  • Operating Room: $99,883.30
  • Billed Charges: $173,676.05
  • ClaimDOC Allowed: $14,656.58
  • Plan Savings: $159,019.47
  • Reduction: 92%
High-Dollar Services: Savings Summary:

3. Tampa, FL

Seven-day hospital stay for the treatment of hypertensive heart disease/failure and related procedure

  • Cath Lab: $64,333.50
  • Laboratory: $60,820.20
  • Room and Board: $30,669.10
  • Billed Charges: $215,493.89
  • ClaimDOC Allowed: $22,525.36
  • Plan Savings: $192,968.53
  • Reduction: 90%
High-Dollar Services: Savings Summary:

4. Indianapolis, IN

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

  • Implants: $216,758
  • Operating Room: $62,301
  • Medical/Surgical Supplies: $59,758
  • Billed Charges: $383,930.65
  • ClaimDOC Allowed: $79,370.26
  • Plan Savings: $304,560.39
  • Reduction: 79%
High-Dollar Services: Savings Summary:

5. Atlanta, GA

Twenty-three day hospital stay for the treatment of stroke, sepsis, complications and related surgery

High-Dollar Services:

  • Operating Room: $259,989
  • Room and Board: $187,243
  • Laboratory: $116,395
  • Pharmacy: $75,586.80

Savings Summary:

  • Billed Charges: $911,888.79
  • ClaimDOC Allowed: $227,062.51
  • Plan Savings: $684,826.28
  • Reduction: 75%

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.