What must an auditor do once the sample is designed?

Once the sample is designed, the auditor’s primary responsibility is to audit the sampled claims. Auditing only the sampled claims allows the auditor to efficiently review a manageable subset of the total claims, drawing conclusions about the overall compliance and accuracy based on this limited review. This method is both time-effective and cost-effective, ensuring that the auditor can assess trends, patterns, and potential issues within the dataset without needing to examine every claim.

Sampling is a common practice in auditing because it is infeasible to analyze every transaction due to the sheer volume of claims in many healthcare settings. By focusing solely on the sampled claims, the auditor can gather sufficient data to evaluate compliance with coding guidelines, billing practices, and regulatory requirements, providing valuable insights for quality improvement.

In contrast to merely sampling claims, conducting a complete audit of all claims is impractical and would not contribute additional insight beyond what could be observed from a targeted sample. Recommendations for future audits or preparing a report on potential fraud may arise as part of the audit process, but these are not the immediate task once the sample is established; the initial focus remains on assessing the sampled claims directly.