Monitor Mondays

The Fatal Blow: “Statistically Valid Extrapolation”

Frank Cohen, SENIOR HEALTHCARE ANALYST | Cate Brantley | Knicole Emanuel, Esq. | David Glaser, Esq. | Ronald Hirsch, MD, FACP, CHCQ Season 14 Episode 663

For years, federal audit contractors have treated statistical extrapolation as the unassailable engine driving massive overpayment demands. 

The premise sounds reasonable enough: review a small sample of claims, calculate an error rate, and multiply across the entire population to produce a "statistically valid" overpayment figure.

In a perfect world, this approach might hold up. 

But healthcare isn't a perfect world. 

It's a domain where coding is inherently subjective, documentation varies dramatically by provider, and even seasoned experts routinely disagree on the same chart. In this environment, extrapolation doesn't multiply truth—it amplifies uncertainty. Join us Monday during the long-running Monitor Monday when senior healthcare analyst Frank Cohen returns to the broadcast to debunk long-held beliefs regarding auditing, auditors and extrapolation. 

Broadcast segments will also include these instantly recognizable features:

·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. 

·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. 

·      Legislative Update: Cate Brantley, legislative affairs analyst for Zelis, will report on the news happening at the intersection of healthcare and congressional action.

·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.