The DOC

November 2022 | Get the latest from the best RBP advocates and auditors 

Industry Perspective

Brad Hansen

VP of Provider Relations

Medicare Reductions from a Lame-Duck Congress? Not likely!

Human Resources Teams are tasked with developing benefit solutions that meet many needs. They recruit new employees with competitive offerings and retain employees by meeting healthcare accessibility needs, all while ensuring the number two corporate expenditures keep the board and CFO happy. To bring it all together, Brokers are trusted to give unbiased guidance and access to solutions. No problem, right? However, once you throw RBP into the conversation, more than likely, someone will utter the generic statement, “it’s bad for members.”

I have been with ClaimDOC for two years after spending 30 years working for the Blues and Aetna. My PPO client service experience gives me an incredible perspective on misperceptions that exist about RBP. It is professionally irresponsible to spread the narrative that RBP is bad for members. If you are tasked with advocating for members, why promote a deal-killer narrative without sufficient expertise to make that statement? Read more...

Audit Spotlight

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

Senior Audit Manager

Substantial Disparities Among Charges for CT Scans - What is a Reasonable Fee?

In this Claims Audit Spotlight, we focus on members undergoing a diagnostic CT scan and the related charges reported and billed by various providers for imaging services. Each billing entity in our analysis reported/billed the diagnostic CT scan using CPT code 74176 (with no modifier).

The improper reporting of services, coding/billing errors and egregious charges can complicate matters for members to understand their healthcare bills and payments, impact the collection of patient balances, build a reputation of providers charging high fees, create burdens for patients having no insurance and a host of others. 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. Coppell, TX

Ambulatory surgical center services for the treatment of osteoarthritis of the spine

High-Dollar Services:

ASC Services: $18,991.60

Radiology: $13,595.40

Anesthesia: $9,028.42

Savings Summary:

Billed Charges: $71,822.33
ClaimDOC Allowed: $566.19
Plan Savings: $71,256.14
Reduction: 99%

2. Concord, NC

Outpatient dialysis services for the treatment of end stage renal disease

High-Dollar Services:

Dialysis Treatment (14): $71,792

Savings Summary:

Billed Charges: $92,338.08
ClaimDOC Allowed: $4,803.26
Plan Savings: $87,534.82
Reduction: 95%

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

I needed to see a provider for an urgent CT scan. I called ClaimDOC, my Member Advocate Robin answered the phone right away. She resolved the issue and helped me BIG TIME. Shout out to Robin!

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