Audit Cases

Audit of treatment for heart disease results in 93% 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. Tomball, TX

Two-day hospital stay for the treatment of heart disease, heart failure and related procedure

High-Dollar Services:

  • Medical/Surgical Supplies: $247,622.00
  • Cath Lab: $171,445.20

Savings Summary:

  • Billed Charges: $552,423.72
  • ClaimDOC Allowed: $37,221.66
  • Plan Savings: $515,202.06
  • Reduction: 93%

2. Largo, FL

Eleven-day hospital stay for the treatment of benign pituitary gland lesion and related surgery

  • Laboratory: $221,000.26
  • Operating Room: $154,339.81
  • Billed Charges: $538,482.77
  • ClaimDOC Allowed: $37,466.32
  • Plan Savings: $501,016.45
  • Reduction: 93%
High-Dollar Services: Savings Summary:

3. Pennington, NJ

Hospital outpatient services for the treatment of uterine leiomyoma and related surgery

  • Surgery: $52,308.00
  • Billed Charges: $109,645
  • ClaimDOC Allowed: $9,306.26
  • Plan Savings: $100,338.74
  • Reduction: 92%
High-Dollar Services: Savings Summary:

4. St. Petersburg, FL

Four-day hospital stay for twin delivery by cesarean section

  • Pharmacy: $313,687.62
  • Billed Charges: $83,714.59
  • ClaimDOC Allowed: $10,294.81
  • Plan Savings: $73,419.78
  • Reduction: 88%
High-Dollar Services: Savings Summary:

5. Los Angeles, CA

Hospital outpatient services for the treatment of disorder of eye and adnexa

High-Dollar Services:

  • Operating Room: $26,948.00

Savings Summary:

  • Billed Charges: $315,754.14
  • ClaimDOC Allowed: $61,928.56
  • Plan Savings: $253,825.58
  • Reduction: 80%

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.