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Featured Audit Plan: Excluded individuals and entities

Healthcare Auditing Weekly, April 22, 2008

Looking for a particular audit plan that may help make your job easier? Turn to the "Audit Plans" section of the Healthcare Audit Resource Center, the home of dozens of audit plans.

This week's featured audit plan is Excluded individuals and entities audit—free for a limited time only to all Healthcare Auditing Weekly readers!

Sign up for the Healthcare Audit Resource Center and gain instant access to all the audit plans, which are ready for immediate downloads as Microsoft Word files. Tip: Effectively use samples in your audits

Choosing an effective population sample is one of the most critical steps in every audit, but it isn’t as easy as closing your eyes and grabbing random medical records. Use the following guidelines when selecting samples:

• Professional judgement. How good is your knowledge of the characteristics of the population?
• Characteristics of the population, such as outliers and number and size of dissimilar items.
• Confidence level (tolerable error) desired. For example, how sure do you want to be that the desired statistic is within a certain range, plus or minus, of the real population mean?
• Strength of controls, like preventing billing errors that lead to overpayments.
• Type of sampling method to be used, such as simple random sampling, stratified random sampling, multistage sampling, discovery sampling, and dollar unit sampling

If you have access to one, a statistician can help you validate your sample. He or she can help you design sample plans and evaluate sample results, determine whether samples represent the population, and determine whether you can use your audit methods to make valid inferences about the population.

This tip is adapted from The Healthcare Auditor’s Handbook. For more information about the book or to order your copy, visit HCMarketplace.

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