Audit Cases

Audit of uterine tumor treatment and related surgery leads to 94% 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. Flowood, MS

Hospital outpatient services for the treatment of non-malignant uterine tumor and related surgery

High-Dollar Services:

  • Operating Room: $103,571

Savings Summary:

  • Billed Charges: $175,472.01
  • ClaimDOC Allowed: $10,210.04
  • Plan Savings: $165,261.97
  • Reduction: 94%

2. Denton, TX

Twelve-day hospital stay for the treatment of multiple injuries due to motorcycle accident

  • Implants: $294,623
  • Operating Room: $195,265.65
  • Room and Board: $139,788
  • Billed Charges: $925,850.93
  • ClaimDOC Allowed: $75,968.42
  • Plan Savings: $849,882.51
  • Reduction: 92%
High-Dollar Services: Savings Summary:

3. Greenville, SC

Three-day hospital stay for the treatment of pediatric cardiac arrest

  • Laboratory: $25,197
  • Billed Charges: $104,688.80
  • ClaimDOC Allowed: $19,190.63
  • Plan Savings: $85,498.17
  • Reduction: 82%
High-Dollar Services: Savings Summary:

4. Snellville, GA

Eight-day hospital stay for the treatment of intestinal adhesions, obstruction, and related surgery

  • Operating Room: $34,592
  • Billed Charges: $113,863.06
  • ClaimDOC Allowed: $22,865.10
  • Plan Savings: $90,997.96
  • Reduction: 80%
High-Dollar Services: Savings Summary:

5. Zion, IL

Ten-day hospital stay for the treatment of primary cancer and chemotherapy

High-Dollar Services:

  • Pharmacy: $163,705.44

Savings Summary:

  • Billed Charges: $318,261.66
  • ClaimDOC Allowed: $85,066.78
  • Plan Savings: $233,194.88
  • Reduction: 73%

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.