Corporate Compliance

Tips for preparing your sample selection

Healthcare Auditing Weekly, December 12, 2006

The sample selection process is one of the most significant audit pieces. It shapes the entire audit process because it determines exactly which records you'll review, and which will influence the overall audit findings.

To get started, you must consider your patient population, the type of sample you'll use, the number of medical records you need to sample, and a host of other questions. Use the following steps:

1. Sample collection. The following are the types of sample collecting:

  • Random-In this method, you randomly select medical records that have ramifications.
  • Focus-Draw a focused sample if you are interested in studying a specific concern, such as diagnosis-related group (DRG) pairs.
  • Convenient-Use this sample to identify potential problem areas that need focus, worker training, or perhaps an expanded audit.
  • Hybrid-This method combines random and focus samples.

    2. Population control. Defining your population is important because you will also want to conduct a follow-up audit. Track your exact methodology in order to make accurate comparisons over time.

    3. Number of medical records. Your patient population affects the number of records required to make your audit worthwhile. The general rule is to never draw fewer than 30 samples, but the use of statistical formulas results in the "gold standard" for appropriate selection. You can use tables to choose your acceptable error rate. These tell you the minimum number of records you need to reach the standard 5% error rate. Also remember that the statistical error rate is different from the audit error rate.

    4. Type of information. Aside from the number of samples you collect, consider the type of information you want to review. You may also consider sampling by demographics, specific physicians or specialties, original coders, and reasons why a change in code occurred. To effectively gather information, use sample selection forms. A good form must be effective and efficient, so you may want to pilot test a new form.

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