Audit Cases

98% savings found after audit of freestanding ER bill

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. Plano, TX

Freestanding ER services for the treatment of hematuria and kidney stone

High-Dollar Services:

  • Emergency Room: $17,098.55
  • Observation (3 hours): $16,222.50

Savings Summary:

  • Billed Charges: $61,922.39
  • ClaimDOC Allowed: $1,507.75
  • Plan Savings: $60,414.64
  • Reduction: 98%

2. Philadelphia, PA

Hospital outpatient services for the treatment of lung cancer and radiation therapy treatments 

  • Radiation Treatments (11): $252,951.00
  • Billed Charges: $252,951.00
  • ClaimDOC Allowed: $21,161.21
  • Plan Savings: $231,789.79
  • Reduction: 92%
High-Dollar Services: Savings Summary:

3. Lone Tree, CO

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

  • Operating Room: $82,368.00
  • Implants: $55,719.00
  • Billed Charges: $210,437.00
  • ClaimDOC Allowed: $18,593.93
  • Plan Savings: $191,843.07
  • Reduction: 91%
High-Dollar Services: Savings Summary:

4. Gainesville, FL

One-day hospital stay for the treatment of gallstones and related surgery

  • Operating Room: $49,492.63
  • Billed Charges: $133,815.59
  • ClaimDOC Allowed: $12,735.73
  • Plan Savings: $121,079.86
  • Reduction: 90%
High-Dollar Services: Savings Summary:

5. St. Petersburg, FL

Eighteen-day hospital stay for the treatment of sepsis, heart attack and related procedure

High-Dollar Services:

  • Laboratory: $154,286.65
  • Pharmacy: $103,373.43

Savings Summary:

  • Billed Charges: $561,779.84
  • ClaimDOC Allowed: $65,218.34
  • Plan Savings: $496,561.50
  • Reduction: 88%

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.