Wiki Auditors opinion on: When is it safe to conclude an audit

clopez

Networker
Messages
47
Location
Murrieta, CA
Best answers
0
Hello,

Seeking guidance:

My department received a hospital case of 75 members with 3,175 line items to review. My coding analyst has indicated that she has reviewed 100 line items, and so far she has found supporting documentation for those 100 line items that we payed (we are thre payor). Are there any industry standards that can guide me as to when is it appropriate to conclude the audit when it's this big and no documentation deficiencies have been identified.

We are trying to develop a policy and procedure to abide by when we face this situation. Any help, guidance and resources are greatly appreciated.

Cindy
 
I would advise using RAT-STATS, this is a free program from the OIG. It will help you determine a statistically valid sample size and will give you the numbers of which lines to pull for your audit.

We use RAT-STATS for all our random sampling and to determine sample size when dealing with a large population like that.

http://oig.hhs.gov/compliance/rat-stats/

Hope this helps,

Laura, CPC, CPMA, CPC-I, CANPC, CEMC
 
Top