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Statistical Services for Medical Billing Compliance & RAT-STATS Expertise

Statistical Services for Medical Billing Compliance & RAT-STATS ExpertiseStatistical Services for Medical Billing Compliance & RAT-STATS ExpertiseStatistical Services for Medical Billing Compliance & RAT-STATS Expertise

Consult with a Professional Statistician


Contact Us

Statistical Services for Medical Billing Compliance & RAT-STATS Expertise

Statistical Services for Medical Billing Compliance & RAT-STATS ExpertiseStatistical Services for Medical Billing Compliance & RAT-STATS ExpertiseStatistical Services for Medical Billing Compliance & RAT-STATS Expertise

Consult with a Professional Statistician


Contact Us

About Us

Richard Remington Professional Statistician RAT-STATS software expert

Richard Remington

 Founder and Principal Statistician 


100s of Medical Billing Compliance Cases

Totaling $500M in Paid Claims


25 Years Experience in Statistical Consulting


Expert Witness in State and Federal Court Cases

healthcare patient care

Need the help of an Expert Statistician?

Statistical Expertise with CMS Program Integrity Manual


Cost-effective Sampling Designs for paid claims


Extrapolation of overpayment


Expertise with RAT-STATS software


Customized statistical programming for complex compliance issues

medical billing compliance audit paid claims demand letter sampling design extrapolation overpayment

We can help with any statistical needs you have

Internal Audits & Self Reporting


Strategy with CMS Contractors, CMS, and OIG


Payor Demand Letters


Expert Witness Services


How We Help

Unlock the Power of RAT-STATS

Sampling Design


When to use a Stratified Design


When to use a Probe Sample


Sample Size Estimation


Random Samples


When to use Post-Stratification


Extrapolation of Reviewed Sample Results


Communicating Findings

CMS Centers for Medicare & Medicaid Services Audit Compliance Demand Letter Self-reporting ZPIC

CMS.gov

Clarify and Strengthen your communications with the Centers for Medicare & Medicaid Services  


Self-Audits


CMS Contractor Audits


Targeting a Level of Precision based on a Confidence Interval


Guarantee Your Results are 100% Reproducible 


Understanding & Responding to a Demand Letter

OIG Office of the Inspector General U.S. Department of Health and Human Services

OIG.HHS.gov

OIG.HHS.gov

Clarify and Strengthen your communications with the Office of the Inspector General


Understanding what OIG means by 

"Full Sample" Size


Allocating a Full Sample Size across a Stratified Design


Understanding & Responding to a Demand Letter



RAT-STATS Limitations

RAT-STATS is a powerful software & It's Free

But there are some limitations to be aware of...

Sample size estimates assume that overpayments are all-or-nothing

Whether or not a patient should have been admitted can lead to all-or-nothing overpayment of inpatient claims.


But billing face-to-face physician care (9921x) at the wrong level doesn't result in all-or-nothing overpayments.


We offer customized statistical programming that better reflects what you know about the paid claims process.

There are no data visualizations to guide choice of sampling design

Data visualizations are essential to developing efficient and cost-effective sampling designs, especially for identifying stratifications that lower the risk of overpayment extrapolations that are biased high.


Data visualizations are also essential to identify items in the populations that are outliers.  Often 100% census review of the outliers is a useful risk-reducing choice, especially when the outliers are large payments.


It's also critical to use data visualizations to check reviewed sample results.  This sometimes reveals a need for post-stratification to avoid costly overestimation of overpayment.


We use data visualization in every sampling design.

There is no support for One-Sided Confidence Intervals

Overpayment is often agreed to be repaid at the lower confidence limit of a one-side confidence interval.


The lower limit of this confidence interval tells us with a given level of confidence that the overpayment is unlikely to be less than this $ amount.


We can provide any confidence interval required for your situation.

Contact Us

To ask a question or schedule a meeting:

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Helpful Resources

RAT-STATS

RAT-STATS - Statistical Software | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services 

Medicare Program Integrity Manual

 100-08 | CMS 

 

  • Chapter 1 - Overview of Medical Review (MR) and Benefit Integrity (BI) Programs
  • Chapter 2 - Data Analysis
  • Chapter 3 - Verifying Potential Errors and Taking Corrective Actions
  • Chapter 4 - Program Integrity
  • Chapter 5 - Items and Services Having Special DME Review Considerations
  • Chapter 6 - Medicare Contractor Medical Review Guidelines for Specific Services
  • Chapter 7 - MR Reports
  • Chapter 8 - Administrative Actions and Statistical Sampling for Overpayment Estimates
  • Chapter 9 - The Medicare Fee-for Service (FFS) Recovery Audit Program
  • Chapter 10 - Medicare Enrollment
  • Chapter 11 - Fiscal Administration
  • Chapter 12 - The Comprehensive Error Rate Testing Program
  • Chapter 13 - Local Coverage Determinations
  • Chapter 14 - Reserved for Future Use
  • Chapter 15 - Medicare Enrollment
  • Chapter 15.4-Processing Guide-855O
  • Chapter 15.5-Processing Guide-855R
  • Exhibits

Statistical Sampling in OIG Reviews (Interview)

 Statistical Sampling in OIG Reviews | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services

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