Study Confirms Methodology BMI Utilizes as Superior
A recent study found in the International Journal of Electronic Healthcare examined the relative efficacy of two different auditing methodologies (100% of claims auditing versus random sampling) for auditing self-funded medical claims expenses. It is important to take note that “100% of claims auditing” includes judgmental selection of samples for an on-site review of documentation.
Some notable findings from the study were that Random Sampling:
failed to identify a significant number and amount of the errors, translating into appreciable financial losses.
missed a significant amount of claims overpaid and underpaid from the data set.
identified fewer claims than 100% sampling.
missed the opportunity to identify the root causes of claim errors not identified by the audit.
depicted employee healthcare utilization less accurately.
Reference:
Klimberg, G and Sillup, G. “Health plan auditing 100-percent –of-claims vs. random-sample audits.” International Journal of Electronic Healthcare 6 (2011): 47-61.