For how many claims should net overpayment or underpayment be identified?

Identifying net overpayment or underpayment involves evaluating a comprehensive view of claims within a defined sampling frame. By analyzing all claims in the sampling frame, the auditing process ensures a thorough assessment of any discrepancies in payment, which helps maintain the integrity of the billing and reimbursement process. This approach minimizes the risk of overlooking any potential issues and provides a complete understanding of the overall compliance and accurate payment practices.

In contrast, focusing only on major claims or selecting a random sample may lead to gaps in the audit process, as these methods may miss smaller claims that could collectively represent significant overpayments or underpayments. Setting a minimum number of claims does not address the necessity of reviewing the entire sample to capture the full extent of the payment landscape. Therefore, auditing all claims in the sampling frame is essential for accurate identification of any net overpayment or underpayment issues.