It depends on your objectives. TFG’s 100 percent audit uses computer technology to re-adjudicate and review every single claim, making sure all payments comply with specific plan rules, and identifying all exceptions. Accordingly, we are able to select a strategically focused sample of claims for on-site validation. Tests have shown that we are able to help our clients identify 4 times as many error categories this way and up to 14 times as many overpayments, compared to random sampling. Knowing what went wrong, by individual claim, allows us to determine what can be done to prevent future overpayments and can also help us guide you toward significantly higher recoveries.
By comparison, random sampling is accomplished by applying a statistical selection methodology to the claims data, providing only a statistically valid understanding of the error types and rates, which creates a reasonable estimate of the percentage of claims that have been incorrectly administered. This statistical methodology, therefore, does not provide any practical or detailed information to make significant process improvements and has significant recovery limitations.