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The DOC

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

Industry Perspective

Ben Krambeck

Cheif Executive Officer

2024 Looking Back and Going Forward

We started Industry Perspectives 3 ½ years ago with the goal of providing relevant insights from our team of experts, with a ClaimDOC spin. Consistent with how we approach everything at ClaimDOC, we weren’t going to try a splashy marketing trick without commitment. We’ve since released 36 editions of Industry Perspectives and this is my 4th annual edition of Looking Back and Going Forward. The great thing about our consistency is just that, a steady effort focused on results. The downside to that pragmatic approach to delivering results is that I don’t get to share a bunch of sexy ideas that sound great in an article (but don’t really drive better results).

We prepare a game plan, we practice hard, we play the game hard, we learn from our mistakes, and we show up the next day at practice ready to do it all over again. We don’t announce every time we put in a new play. We don’t announce every time we get stronger. Our clients and brokers expect those things from us. They don’t hire us to try, they hire us to succeed. We have built this business by being focused on client success and building tools that improve the odds of client success instead of chasing how to win the next piece of business. My primary themes are the exact same as they have always been:

Pride in our people
Pride in our model
Refine and improve
Stay focused on the fundamental mission of providing an affordable medical plan alternative
Build relationships with those who understand and appreciate why we are different

Audit Spotlight

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

Senior Audit Manager

Remarkable Variations of Facility Charges for Hip Replacement Surgery

In this Claims Audit Spotlight, we focus on remarkable variations of facility charges for hip replacement surgery, also known as hip arthroplasty. Hip replacement surgery is a commonly performed procedure to assist individuals with hip damage due to arthritis, injury, or other conditions to regain mobility. Given the average life span of Americans, many older adults who receive a new hip are in their 60s or 70s. Artificial hips have limited life spans and some individuals will require a revision surgery to take out the old and replace it.

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. Tomball, TX

Two-day hospital stay for the treatment of heart disease, heart failure and related procedure

High-Dollar Services:

Medical/Surgical Supplies: $247,622
Cath Lab: $171,445.20

Savings Summary:

Billed Charges: $552,423.72
ClaimDOC Allowed:$37,221.66
Plan Savings: $515,202.06
Reduction: 93%

2. Largo, FL

Eleven-day hospital stay for the treatment of benign pituitary gland lesion and related surgery

High-Dollar Services:

Laboratory: $221,000.26

Savings Summary:

Billed Charges: $538,482.77

ClaimDOC Allowed: $37,466.32
Plan Savings: $501,016.45
Reduction: 93%

More Sample Audit Results

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.

Client Experience

Feedback from an Employer

"Our Member Advocate, Teah, is thorough, on task, and follows up with detailed information. She helps reduce the effort for us as an employer and for our staff as well! Thank you, Teah!"

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