The Randomness of a Random Number

By Jaci Johnson, CPC, COC, CPMA, CPC-I, CEMC
What is the true value of a random selection in an audit? I ponder this all the time… really I do.
Unless the auditor is acting as an IRO for a CIA as part of an OIG agreement and the random selection is required, what’s the point? Lets consider why we audit? Is it to find areas of risk? Is it to find an opportunity? Maybe both. If we rely on a random selection, what if 50-80 percent of that random selection is all the same codes or family of codes? Would that be helpful to me as an auditor? Would that be helpful to me if I were the provider? This could hold true for an E/M audit as well as any surgical audit. If my purpose is to provide good feedback and quality information would not a little focus thrown into the random be a better approach?
Maybe size of the scope and size of the selection play a part in the need for randomness in the selection. If only 10 claims are needed for an audit and the scope is the last three month of claims…which selection process will provide most benefit? Random or focused-random?  However if the need is for 200 claims and the scope is the last five years of claims data, then, maybe random is the way to go?
Random provides a sense of validity… I get that. For some providers that random selection tells them you were not “out to get them”. But does it also provide a false sense of security?
On the flip side (to be fair), if I add focused to my random, am I ignoring trends? Am I forcing myself to see something that maybe is not there? If we add a focus are we forgetting about all the services or items that do not fall into focus?
To best decide I guess we start with the first question…why audit? If the intent is to evaluate a problem then maybe my scope is focused and my selection is random. If my intent is to give some feedback for a provider who has never been audited, or if it has been a few years since the last one…then maybe just random scope and random selection.
Just a few random thoughts:
Does the word random sound as serious as the word focused? Does random mean, “oh, what the heck, I guess I will pull some notes.” Or, does the word random make you think, “This audit is not aimed at trying to pin something on you.”
 
 

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Jaci Kipreos

Jaci Kipreos, CPC, COC, CDEO, CPMA, CRC, CPC-I, CEMC, has been in the field of medical coding and auditing for over 30 years and received a Bachelor of Science degree in finance from Virginia Tech. She has worked in a variety of practice settings and has expertise in coding for family practice, urgent care, obstetrics and gynecology, general surgery, and Medicare’s teaching physician guidelines, with an emphasis on compliance with evaluation and management guidelines. Kipreos has been an instructor for various AAPC workshops for the past 10 years and is a frequent speaker at AAPC’s national and regional HEALTHCON conferences. She has also provided presentations for the American Association of Nurse Practitioners state event in Virginia and the national event for the American Association of Medical Assistants. Kipreos is a past president of the Richmond, Virginia and Charlottesville, Virginia local chapters, and served as president of AAPC’s National Advisory Board from 2015 to 2018.

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