If a CIA or Settlement Agreement does not include detailed billing review requirements, what are the OIG guidelines?
Answer 1: Although not expressly required by all CIAs, the OIG suggests billing reviews be conducted in accordance with the following guidelines: A probe sample, of at least 30 sampling units, should be examined. The units for the probe sample should be randomly selected using a random number generator. (Many CIAs and Agreements require that OIG’s RAT-STATS program be used to generate the random numbers.) When conducting the review, the reviewer should focus on the dollar difference between the provider’s actual reimbursement and what the provider should have been reimbursed (based on contractor and HCFA policies). Results from the probe sample allow the reviewer to make estimates about the overpayments in the population. As a result, the reviewer can estimate how many sampling units will need to be reviewed to achieve certain confidence and precision levels. A 90% confidence and 25% precision level is required in current CIAs. If a provider’s Agreement or CIA does not specify confiden
Related Questions
- If a CIA or Settlement Agreement does not include detailed Claims Review requirements, what guidelines should a provider follow?
- If a CIA or Settlement Agreement does not include detailed billing review requirements, what are the OIG guidelines?
- What information should be reported to the OIG in the billing review findings, as part of an entitys Annual Report?
