What sampling unit should be used?
A sampling unit is any discrete unit that can be sampled (e.g., code, line item, beneficiary, patient encounter). For any sampling methodology used, each sampling unit in the population should have a known chance of selection. The sampling unit is selected and defined by the reviewer and should be consistent with the objective of the Claims Review. The manner in which a provider maintains its records may influence the sampling unit to be used. For example, if a provider keeps all information in the patient’s chart and cannot easily retrieve the information by claim or line item, the better sampling unit is the beneficiary (e.g., patient chart or record), because an accurate population based on another characteristic could not be easily determined.
Answer 6: A sampling unit is any discrete unit that can be sampled (e.g., code, line item, beneficiary, patient encounter). For simple random samples, each sample unit in the population should have a distinct and equal chance of selection. For stratified samples, each item within each strata should have a distinct and equal chance of selection. The sampling unit is selected and defined by the reviewer and should be consistent with the objective of the billing review. The way a provider keeps its records may influence how a sampling unit is defined. For example, if a provider keeps all information in the patient’s chart and cannot retrieve the information by claim or line item, the better sampling unit is the beneficiary (e.g., patient chart or record) because an accurate population based on another characteristic could not be easily determined.
