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What Is the Minimum Sample Size When Self-Disclosing a Billing Issue?

Posted By: Bret S. Bissey, MBA, FACHE, CHC, CMPE / April 24, 2015

According to the self-disclosure protocol, the minimum sample size is 100 claims to be looked at in a study or review. Now, there are intricacies and matters associated with that that healthcare providers should review with their counsel or their respective consultants that are looking at probe samples, statistical studies and analysis to determine the actual methodology of RAT-STATS, statistics and other manners that are acceptable by the government, but to answer your question briefly, 100 claims is the minimum.

Bret S. Bissey, MBA, FACHE, CHC, CMPE

Prior to joining MediTract, Mr. Bissey was the SVP, chief ethics and compliance officer at UMDNJ, where he successfully led the compliance program to adherence with a rigorous five-year Corporate Integrity Agreement with the DHHS/OIG that occurred following a Deferred Prosecution Agreement. Prior to UMDNJ, Bissey served as the director of the Regulatory Compliance Practice at IMA Consulting, the chief compliance and privacy officer at Deborah Heart and Lung Center (operating under a CIA) and the VP of compliance at Cabot Marsh/QuadraMed. Mr. Bissey earned a Bachelor of Science in business administration and marketing from Shippensburg University of Pennsylvania and an MBA in marketing and healthcare administration from Wilkes University. Mr. Bissey is a frequent national speaker on healthcare compliance and is the author of The Compliance Officer’s Handbook. He is a Fellow of the American College of Healthcare Executives and a member of the Health Care Compliance Association (CHC), American College of Medical Practice Executives and the Healthcare Financial Management Association.