Egregious Charges, Price Transparency and Pricing Tools
In this month’s Audit Spotlight, we focus on a claim example where our audit team zoomed in closer on the billed services and related charges.
Resources
Audit of Hospital Stay and Surgery Saves Member $10,391.10
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
New Codes, Guidelines, Medical Billing Considerations in 2025
The complexities surrounding medical coding, billing and submitting an accurate claim the first time is a given. Anyone in the business of healthcare will attest…
Audit of 5-Day Hospital Stay Results in $2,730.01 in Member Savings
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
The Importance of Thoroughly Reviewing Medical Bills
A single visit to a hospital emergency room or the hospital outpatient department can result in a complex array of medical bills covering several services…
Member Saves $3,428.85 on Cancer Treatment, Surgery
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
The Merit of Auditing Healthcare Claims
Successful auditing of medical claims does not merely identify problems, it also pushes healthcare providers to bill honestly and follow coding and billing guidelines/regulations, assists…
Member Saves $14,046.68 After Audit of Hospital Stay
With DirectAccess+, clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and…
Validated — Double-Billing on Healthcare Claims Is Real
Background ClaimDOC’s comprehensive line-by-line review of claims uncovers errors that basic claim repricing and auto-adjudication do not catch, leading to greater savings for medical plans…