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health care

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  • #25571

    howe
    Participant

    A team completed a review of our facility’s records by examinining a statistically valid random sample of all claims filed under this provider for dates of service January 1 2004 throughMarch 31, 2005. 
    There were 16 claims with exceptions identified (within the valid random sample of 149claims), which resulted in an overpayment of $219.95. This amount, divided by the number of claims in the random sample, and then multiplied by the total population of claims for the identified dates of service,equals the total extrapolated overpayment of $36,077.70
    $219.95x 24400=$36,077.
    ______
    149
    Does this calculation seem a little far fetched? I am questioning the arbitrary choice of the 15 months thereby increasing the number of claims made.  If the time frame was 7 and one half months the final number would be half of this.There were many things wrong with the review but I am asking if the 149 claims of 24,440 is a stistically valid number.?  . It is .6% of the total number of claims .
     

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    #61775

    Lorax
    Participant

    Mike,
     
    Any sampling will lead to an amount of error.
    The $60,000,000 question is how much error can be tolerated in this specific situation?
     
    Is it absolutely necessary, to know to the penny, how much over or underpayment happened in the period? (if so you had better go though every single claim and get a number)
     
    If on the other hand you are trying to roughly assess the size of the underpayment problem to the nearest million dollars, then some approximations are tolerable.
     
    The calculation that you posted doesn’t seem awful if this is the case. If you pick a time period other than 15 months, the number of claims made in that period in the calculation will change (so the 24400 will vary) and compensate.
     
    Lorax

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