Audit Cases

98% bill reduction after audit of four dialysis treatments

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. Portland, ME

Outpatient clinic dialysis treatments (4) for the treatment of end stage renal disease

High-Dollar Services:

  • Pharmacy: $38,249.98
  • Dialysis Treatments (4): $33,645.72

Savings Summary:

  • Billed Charges: $72,179.70
  • ClaimDOC Allowed: $1,645.68
  • Plan Savings: $70,534.02
  • Reduction: 98%

2. Valparaiso, IN

Hospital outpatient services for the treatment of left foot wound and staph infection

  • Pharmacy: $104,013
  • Billed Charges: $127,643
  • ClaimDOC Allowed: $15,022.98
  • Plan Savings: $122,620.02
  • Reduction: 88%
High-Dollar Services: Savings Summary:

3. Victoria, TX

Hospital outpatient services for the treatment of colon cancer and immunotherapy

  • Pharmacy: $217,189.56
  • Billed Charges: $220,886.08
  • ClaimDOC Allowed: $28,489.36
  • Plan Savings: $192,396.72
  • Reduction: 87%
High-Dollar Services: Savings Summary:

4. Atlanta, GA

Five-day hospital stay for the treatment of appendix malignancy and related surgery

  • Operating Room: $70,809
  • Billed Charges: $143,272.04
  • ClaimDOC Allowed: $25,430.04
  • Plan Savings: $117,842
  • Reduction: 82%
High-Dollar Services: Savings Summary:

5. Houston, TX

Three-day hospital stay for the treatment of spinal disc degeneration and related surgery

High-Dollar Services:

  • Implants: $343,098
  • Operating Room: $33,658.91

Savings Summary:

  • Billed Charges: $440,898.33
  • ClaimDOC Allowed: $103,209.03
  • Plan Savings: $337,689.30
  • Reduction: 76%

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.