ClaimDOC' s comprehensive line-by-line auditing uncovers errors that basic repricing and auto-adjudication do not catch, leading to greater savings to health plans and beneficiaries.
JUL 2020 | Get the latest from the best RBP advocates and auditors
Audit Spotlight
Cynthia Swanson
RN, CPC, CEMC, CHC, CPMA, Senior Audit Manager
Background
ClaimDOC' s comprehensive line-by-line auditing uncovers errors that basic repricing and auto-adjudication do not catch, leading to greater savings to health plans and beneficiaries. Our audit team analyzes all types of healthcare claims for a variety of potential concerns including excessive usual and customary charges, duplication of claims, correct coding edits, unbundling of services, and others. Our claims review is not intended to impact care decisions or medical practice.
Case Scenario
Member was admitted to the hospital as an inpatient for elective spinal surgery, resulting in a seven-day stay. The hospital claim and charges submitted to insurance totaled $631,087.06. The primary diagnosis reported on the claim reflects lumbar spinal stenosis. Read more..
Client Savings
Comprehensive line-by-line claim auditing by healthcare professionals is used to uncover errors typically not caught. ClaimDOC publishes five recent client savings audit results bi-monthly. See the savings below and know that together we can make healthcare affordable.
1. Sacramento, CA
Two-day hospital stay for the right hip replacement surgery
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.
Broker Experience
Account Manager Feedback from a Broker
“I want you to know how impressed I am with your demeanor, professionalism, capability and responsiveness. I’ve been in this industry a long time and work with a lot of vendors and rarely do I come across someone with your combination of skills. I genuinely mean that and you have a standing job offer with our firm and any of our partner firms. We so appreciate all your help.”
Senior Partner
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ClaimDOC, 3200 Westown Parkway, West Des Moines, IA 50266, 1-888-330-7295
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