What is the sample for retrospective audits usually created from?

The sample for retrospective audits is typically created from a report generated within the billing system. This approach allows auditors to analyze a structured and comprehensive dataset that reflects actual billed services and payments. By utilizing a billing system report, auditors can ensure that the data is relevant, accurate, and directly tied to the services rendered. This method also helps to streamline the audit process because the report aggregates necessary billing information, making it easier to assess compliance, identify trends, and uncover areas that may need further attention or training.

Other options, while they could be involved in some aspects of auditing, do not specifically represent the most effective method of creating a sample for retrospective audits. A random selection of patients may introduce variability that doesn’t necessarily reflect billing practices accurately. Claims submitted to Medicare might focus only on those specific instances, potentially omitting a broader context needed for an effective audit. Finally, the total number of audits conducted in the year doesn’t provide actionable sampling data, as it measures quantity rather than the specific information required for a detailed retrospective audit.