CHC Auditing & Monitoring (2) questions with correct answers

A healthcare provider must repay to Medicare money paid for a specific type of billed claim. What type of audit is the MOST likely one used to identify the amount of repayment? - Answer Full statistical audit A Physician practice are having a hard time determining which claims have been paid in full, and which claims have not been paid at all. What test would be practical for the group to perform to validate the claims that have been paid or not paid. A. Statistical Sampling B. Rat-Stats C. Snap Shots D. Random Sampling - Answer A. Statistical Sampling Regarding statistical sampling, what is an example of failed efforts to use statistical analysis? a. Users who did not understand subject matter or application of sampling. b. A well-rounded data sample c. Knowledgeable staff who are involved in the process d. Investigations done of improper billing practices - Answer a. Users who did not understand subject matter or application of sampling. The use of qualified personnel and adequate resources is key. Use of experts, when appropriate. What is RAT STATS?