The Randomness of a Random Number

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  • March 18, 2015
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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.”

Jaci Kipreos

About Has 7 Posts

Jaci Johnson Kipreos, CPC, COC, CPMA, CPC-I, CEMC, president of AAPC’s National Advisory Board, has been working in the field of medical coding and auditing for over 28 years and has been a CPC® since 1994. She teaches PMCC and manages a national client list, providing compliance monitoring for provider documentation. Kipreos was recognized as Coder of the Year in 2006 for the state of Virginia. She has served office as president for the Richmond and Charlottesville, Virginia, local chapters. Kipreos received her Bachelor of Science in finance from Virginia Tech.

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