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Medicare Issues Statistical Sampling Marching Orders To Contractors
In hopes of increasing consistency across contractors, Medicare recently sent new statistical sampling instructions. “To ensure that contractors are using uniform and consistent procedures when performing statistical sampling, this CR updates the instructions” for Unified Program Integrity Contractors, Recovery Audit Contractors, the Supplemental Medical Review Contractor, and Medicare Administrative Contractors “regarding the use of statistical sampling in their reviews and estimation of overpayments,” says Transmittal 10067 issued Sept. 28. “These changes will help ensure that a probability sample drawn from the sampling frame of the target population yields an estimate of an overpayment in the target population,” the CR says. Addition: “The contractor shall obtain approval from CMS prior to issuing a findings letter to the provider/supplier when the estimated overpayment exceeds $500,000 or is an amount that is greater than 25 percent of the provider’s/supplier’s Medicare revenue received within the previous 12 months,” reads one of the instruction changes. See the transmittal online at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2018Downloads/R828PI.pdf.
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