The DOC

Nov 2020 | Get the latest from the best RBP advocates and auditors 

Industry Perpectives

Cynthia Swanson, RN, CPC, CEMC, CHC, CPMA

Senior Audit Manager

COVID-19 billing observations and information

We released an Audit Spotlight in our last newsletter related to a COVID-19 claim. The claim example generated many questions from the brokers and clients we work with. As such, we have summarized additional ClaimDOC observations and insights regarding COVID-19 and health insurance claims.

As COVID-19 emerged, ClaimDOC observed a decrease in claims for nonemergency surgeries and office visit services. While only temporary, these services are essential contributions to patient health. 

ClaimDOC has recently seen an acceleration of claims being submitted for patients either being screened for COVID-19 or patients having a definitive diagnosis of COVID-19, either with no symptoms, mild symptoms, or extremely severe symptoms. Claims reported/billed with only a single diagnosis of COVID-19 appear rare. Most claims contain additional signs, symptoms, or other diagnostic codes. It is anticipated that any related long-term patient effects may not be known for some time. 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. Pittsburgh, PA

Eight-day hospital stay for the treatment of complications related to childbirth

High-Dollar Services:

Laboratory Services: $22,754.50
Room and Board: $21,280.00
Anesthesia: $17,074.00
Pharmacy: $11,872.50

Savings Summary:

Billed Charges: $103,137.00
ClaimDOC Allowed: $18,068.92
Plan Savings: $85,068.08
Reduction: 82%

2. New Braunfels, TX

Two-day hospital stay for the treatment of severe infection, pneumonia, and kidney failure

High-Dollar Services:

Respiratory Services: $24,988.00
Operating Room: $15,540.00
Room and Board: $15,480.00

Savings Summary:

Billed Charges: $82,309.00
ClaimDOC Allowed: $17,828.51
Plan Savings: $64,480.49
Reduction: 78%

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.

Member Experience

Feedback from an Employer

My Member Advocate Janelle helps me literally every single day. She is so quick to respond and always on the ball. Having a direct phone number to her is critical to our partnership. I don't know what I would do without her. She is amazing!

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