The DOC

November 2024 | Get the latest from the best RBP advocates and auditors 

Audit Spotlight

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

Senior Audit Manager

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 and practitioners. Some medical bills provide minimal information to justify charges while others contain codes/descriptions that make little sense to a layperson.

The complexity of the medical billing maze in healthcare continues to expand. It seems many of the same old things in healthcare are duplicated which in many aspects has not worked very well over the last decade. Read more...

DirectAccess+ Savings

DirectAccess+™ clients and members achieve maximum protection and savings. To establish savings information, ClaimDOC analyzes commercial contract pricing from data disclosed by hospitals and health plans. The audit team performs line-by-line claim audits to help clients and members maximize their savings. Below is one recent audit result showcasing substantial savings.

Columbus, Georgia

Five-day hospital stay for the treatment of pancreatic cancer and malnutrition

Traditional Network Plan

• Hospital Bill: $53,448.60
• Median Commercially Contracted Price
  •  $31,306.83

• Patient Responsibility 20% Coinsurance:
  •  $6,261.37

DirectAccess+

• Hospital Bill: $53,448.60
• ClaimDOC Allowable
  • $17,656.79

• Patient Responsibility 20% Coinsurance:
  • $3,531.36

• Plan Savings: $13,650.04
• Member Savings: $2,730.01

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

"Amanda is on top of things. I asked about a claim, and she got back to me within 48 hours! She took over a large number of claims for me that I have been trying to get taken care of for a long time. I think she is a great example of how claims should be handled."

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