Medical Auditing Practice Exam 2025 – Comprehensive Prep Resource

The purpose of using RAT-STATS to create a Discovery Sample for a Claims Integrity Audit (CIA) Claims Review is primarily focused on identifying the financial error rate of the selected sample. RAT-STATS is a statistical tool used by auditors and analysts to help ensure that the sample drawn is representative of the population, which is critical for accurately estimating that error rate.

When auditing claims, it is essential to assess the quality and accuracy of submissions. By using RAT-STATS, a statistically valid approach is taken to draw a sample that reflects the larger population's characteristics. Once the sample is collected, the auditor analyzes it for errors, calculating the financial error rate based on the proportion of claims within the sample that demonstrate inaccuracies such as overpayments or underpayments.

This process not only helps in identifying the financial integrity of claims but also informs broader decisions on compliance and policy adjustments required to improve quality in claims submission practices, making the identified error rate crucial for the overall audit findings and future safeguards.