BC Advantage - 2019 Issue 5

The Myth about Pass Fail Rates for Providers

Many of the organizations with whom I engage feel a need to use the results of individual provider audits to infer an overall pass/fail rate within the organization. I get the reason for this; leadership wants a general idea of what their compliance risk looks like and they often want to know which providers are contributing most to that risk. The problem comes with respect to both sampling methods and sample sizes for those audits.  For example, an organization using a legacy model, such as a probe audit, might have a mandate to audit 10 encounters per...

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