tci Part B Insider - 2004 Issue 8

Statistical Sampling:Carriers Have More Leeway To Use Smaller Sample Sizes

One reason why carriers don't always play it safe with overpayments: the standards are lax for the use of statistical sampling, says attorney Craig H. Smith with Hogan & Hartson in Miami. It used to be that carriers had a strict standard, in an appendix to the Medicare Carriers Manual, for the number of claims they had to audit before they could perform a statistical sample and extrapolate to all other claims, notes Smith. But in Program Memo B-01-01, issued January 2001, Medicare threw out that standard and replaced it with vague instructions saying that the size of...

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