The DOC

Jan. 2022 | Get the latest from the best RBP advocates and auditors 

Industry Perspective

Ben Krambeck

CEO

Looking Back and Going Forward

As I revisited my version of this article from the prior year it really struck me the consistent themes in our business:

• Pride in our people
• Pride in our model
• Desire to continue to refine and improve
• Concern the RBP industry is losing its focus on the mission
• Excitement over the many great relationships we are building with clients and brokers that understand why we are different and why it’s important

Last year I highlighted how ClaimDOC continues to deviate from the vendor pack by focusing on doing the hard work to create a sustainable plan and I’ll do my best not to beat that differentiator drum (you should be hearing it from our sales team on a regular basis). I will hopefully have some fresh thoughts regarding the industry and insights into ClaimDOC.

Let’s start with the broker community. Building out an exceptional and experienced sales team with a full year of conversations is taking us into unchartered territory. My time selling was mostly with distribution partners that arrived at our door via mutual relationships. They knew what we did and their ability, interest, and motivation aligned with ours. What I didn’t fully appreciate is how rare that is. There are many willing to talk about RBP, however, the ones with the courage to go against the grain are not common. The lack of consultative direction by a great number of brokers handing their clients massive renewals heading into 2022 was extremely telling. I have challenged my sales team to be more discerning with who they spend their time with in 2022. Always be willing to educate someone interested in learning, however, let’s not spend time with someone not interested in selling. Read More....

Audit Spotlight

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

Senior Audit Manager

ClaimDOC uncovers excessive charges for physician/professional services resulting in huge savings

A member with the diagnosis of varicose veins of the right and left lower extremities/without complications were seen in the physician’s office setting and underwent the procedure of CPT code 36475. This procedure code is defined as, “Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency, first vein treated.” The procedure consists of the physician inserting a specially designed radiofrequency probe through the skin which subsequently destroys the walls of a diseased vein in an extremity. 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. Turlock, CA

Five-day hospital stay for treatment of sepsis

High-Dollar Services:

Operating Room: $56,268
Laboratory: $24,082.83
Room and Board: $17,524

Savings Summary:

Billed Charges: $196,060.83
ClaimDOC Allowed: $22,111.80
Plan Savings: $173,949.03
Reduction: 89%

2. Fayetteville, GA

Hospital outpatient services for the treatment of cancer of pelvic tissue and radiation treatments (13)

High-Dollar Services:

Radiation Treatments (13): $94,991
Radiotherapy Dose Planning: $12,303

Savings Summary:

Billed Charges: $120,150
ClaimDOC Allowed: $14,903.22
Plan Savings:$105,246.78
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.

Broker Experience

Feedback from a Broker

I was on an introductory call with one of my new clients and I can’t even begin to tell you how impressed I am with Samantha. It’s unbelievable how knowledgeable she is and how clearly she communicates the onboarding plan. I wish all my accounts were with ClaimDOC so I could work with Samantha. After our first call, all I could say was, WOW!

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