The DOC

Nov. 2021 | Get the latest from the best RBP advocates and auditors 

Audit Spotlight

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

Senior Audit Manager

Huge savings after ClaimDOC audit team analyzes outpatient dialysis billing

In this Claims Audit Spotlight, the focus is on coding, billing, and compliant reporting of dialysis services for patients with the diagnosis of end-stage renal disease (ESRD).

We analyze numerous claims billed by or on behalf of freestanding dialysis centers. Free-standing dialysis centers provide chronic maintenance dialysis to ESRD patients on an outpatient basis, and some centers may additionally provide dialysis services in the patient’s place of residence.

A dialysis center may be designated as an independent or hospital-based unit (that is, either hospital units or hospital satellites). Most individuals select a dialysis center that is a location convenient to where they reside and/or work. There are thousands of dialysis facilities across the country. Read More....

Client Savings

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. Salem, VA

Hospital outpatient services for the treatment of leiomyoma of the uterus

High-Dollar Services:

Operating Room: $41,685
Medical/Surgical Supplies: $12,971
Recovery Room: $9,305

Savings Summary:

Billed Charges: $75,907
ClaimDOC Allowed: $10,290.80
Plan Savings: $65,616.20
Reduction: 86%

2. Atlanta, GA

Hospital outpatient services for the treatment of retinal detachment

High-Dollar Services:

Operating Room: $27,676
Medical/Surgical Supplies: $9,727.04
Recovery Room: $7,803

Savings Summary:

Billed Charges: $55,649.96
ClaimDOC Allowed: $9,298.80
Plan Savings: $46,351.16
Reduction: 83%

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 a Member

My Member Advocate Maureen was so helpful. I'm was moving and didn't have access to the mailbox my card was being sent to. I was really worried about something happening and not having my insurance cards. I emailed Maureen about my concerns and she responded so quickly! She helped me out and made sure my insurance cards were sent to the correct address. She is awesome and people like her are the ones who save the day. Thank you, Maureen!

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