Audit Cases

Audit of breast cancer treatment results in 98% 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. Tampa, FL

Hospital outpatient services for the treatment of breast cancer and chemotherapy

High-Dollar Services:

  • Pharmacy: $51,840

Savings Summary:

  • Billed Charges: $53,779
  • ClaimDOC Allowed: $877.89
  • Plan Savings: $52,901.11
  • Reduction: 98%

2. Concord, NC

Outpatient dialysis clinic services for the treatment of end stage renal disease

  • Dialysis Treatments (13): $7,331
  • Billed Charges: $116,386.27
  • ClaimDOC Allowed: $4,479.54
  • Plan Savings: $111,906.73
  • Reduction: 96%
High-Dollar Services: Savings Summary:

3. Weirton, WV

One-day hospital stay for the treatment of heart attack and related procedure

  • Cath Lab: $114,348
  • Billed Charges: $133,362.50
  • ClaimDOC Allowed: $15,308.39
  • Plan Savings: $118,054.11
  • Reduction: 89%
High-Dollar Services: Savings Summary:

4. Tampa, FL

Six-day hosptial stay for the treatment of benign neoplasm of facial bones and related surgery

  • Operating Room: $86,748
  • Anesthesia: $71,958
  • Pharmacy: $50,507.28
  • Room and Board: $44,000
  • CT Scans: $26,949
  • Radiology: $26,715
  • Billed Charges: $394,070.54
  • ClaimDOC Allowed: $55,130.98
  • Plan Savings: $338,939.56
  • Reduction: 86%
High-Dollar Services: Savings Summary:

5. Stockburger, GA

Hospital outpatient services for the treatment of heart attack, anemia and related procedure

High-Dollar Services:

  • Cath Lab: $103,068

Savings Summary:

  • Billed Charges: $149,478.81
  • ClaimDOC Allowed: $21,910.87
  • Plan Savings: $127,567.94
  • 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.