Audit Cases

Audit of treatment of chest pain 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. Overland Park, KS

Hospital outpatient services for the treatment of chest pain and related procedures

High-Dollar Services:

  • Cardiac Tests: $25,522.42

Savings Summary:

  • Billed Charges: $58,475.72
  • ClaimDOC Allowed: $2,887.30
  • Plan Savings: $55,588.42
  • Reduction: 95%

2. Sylacauga, AL

Air ambulance services between hospitals for the treatment of atrial fib and complications of heart stent

  • Air Ambulance: $79,999
  • Billed Charges: $79,999
  • ClaimDOC Allowed: $6,443.52
  • Plan Savings: $73,555.48
  • Reduction: 92%
High-Dollar Services: Savings Summary:

3. Orange Park, FL

Hospital outpatient services for the treatment of atrial fibrillation and related procedure

  • Cath Lab: $208,023
  • Medical/Surgical Supplies: $100,082
  • Billed Charges: $411,296.30
  • ClaimDOC Allowed: $37,010.15
  • Plan Savings: $374,286.15
  • Reduction: 91%
High-Dollar Services: Savings Summary:

4. Victoria, TX

Nine-day hospital stay for the treatment of chronic obstructive pulmonary and respiratory failure

  • Laboratory: $44,865.64
  • Room and Board: $44,801.55
  • Respiratory: $35,729.94
  • Billed Charges: $270,283.39
  • ClaimDOC Allowed: $25,532.85
  • Plan Savings: $244,750.54
  • Reduction: 91%
High-Dollar Services: Savings Summary:

5. Anchorage, AK

Hospital outpatient services for the treatment of left hip osteoarthritis and related surgery

High-Dollar Services:

  • Implants: $84,331

Savings Summary:

  • Billed Charges: $143,301.26
  • ClaimDOC Allowed: $18,527.01
  • Plan Savings: $124,774.25
  • Reduction: 87%

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.