Medical Auditing Practice Exam

A sample gathered of high dollar CPT®/HCPCS codes is considered what type of sampling?

1. Random sampling

2. Proportional sampling

3. Systematic sampling

4. Cluster sampling

The correct answer is: Proportional sampling

The correct answer, proportional sampling, is relevant when the sample taken reflects the underlying structure of the population, ensuring each segment is represented in accordance with its proportion within the entire dataset. In the context of high dollar CPT®/HCPCS codes, this approach allows auditors to focus on significant claims that can have a larger impact on overall billing practices and compliance. By utilizing proportional sampling, auditors can ensure that the samples drawn accurately represent the different categories of high dollar codes as they exist in the population, leading to a more informed assessment and audit. This helps to identify patterns or discrepancies effectively without bias towards any specific group. Other sampling methods, like random, systematic, or cluster sampling, do not specifically ensure that high dollar codes are adequately represented in relation to their prevalence in the total dataset. Random sampling may lead to underrepresentation or overrepresentation of certain codes; systematic sampling relies on fixed intervals, which might not properly capture variability in claim amounts; and cluster sampling groups populations in larger segments rather than focusing on the specific high dollar claims that are essential for targeted auditing in this context.