Audit Cases

Audit of dialysis treatments leads to 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. Fort Worth, TX

Outpatient clinic dialysis treatments for the treatment of end-stage renal disease

High-Dollar Services:

  • Pharmacy: $62,823.00

Savings Summary:

  • Billed Charges: $94,398.46
  • ClaimDOC Allowed: $980.37
  • Plan Savings: $93,418.09
  • Reduction: 99%

2. Philadelphia, PA

Twenty-three day hospital stay for the treatment of prostate cancer and radiation therapy

  • Radiation Treatments (23): $392,771.00
  • Billed Charges: $416,765.00
  • ClaimDOC Allowed: $19,773.42
  • Plan Savings: $396,991.58
  • Reduction: 95%
High-Dollar Services: Savings Summary:

3. Newnan, GA

Hospital outpatient services for the treatment of right knee osteoarthritis and related surgery

  • Operating Room: $33,429.00
  • Implants: $28,007.55
  • Billed Charges: $94,642.74
  • ClaimDOC Allowed: $15,806.68
  • Plan Savings: $78,836.06
  • Reduction: 83%
High-Dollar Services: Savings Summary:

4. Des Moines, IA

Hospital outpatient services for the prophylactic surgery/removal of left breast

  • Operating Room: $33,429.00
  • Implants: $28,007.55
  • Billed Charges: $127,340.96
  • ClaimDOC Allowed: $26,724.69
  • Plan Savings: $100,616.27
  • Reduction: 79%
High-Dollar Services: Savings Summary:

5. Fort Smith, AR

Hospital outpatient for the treatment of coronary artery disease and related procedure

High-Dollar Services:

  • Cath Lab: $51,701.00

Savings Summary:

  • Billed Charges: $56,229.82
  • ClaimDOC Allowed: $11,835.28
  • Plan Savings: $44,394.54
  • Reduction: 79%

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.