Is it appropriate to use alternate or spare records in the billing review?
Answer 21: Generally, the use of alternates or spares is not permissible for CIA billing reviews, as stipulated in current CIAs. If a record or supporting documentation can not be located, the reviewer should consider this item (e.g., claim, line item, encounter) to be an error/overpayment. Question 22: If the actual precision for the full sample does not meet the 90% confidence and 25% precision threshold (as stipulated in most CIAs), do additional sampling units need to be reviewed in order to achieve the specified confidence and precision levels? Answer 22: If the sample size of the billing review was determined by RAT-STATS to reach a 90% confidence and 25% precision level, and if the actual confidence or precision level results do not meet the specified requirements, the reviewer does not need to continue the review. The number of sampling units identified by RAT-STATS is an estimate of the number of units to be reviewed. This number is based on the results of the probe sample. Be
