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Of the overall population would not really matter. I just wanted to make that clear. You need to identify yourself. This is ann fulton with hewitt. Claim audit process. This is a review again from what we reviewed during our audit process. There were questions in our out of sample claim. This is an example, an emergency room claim if we identified an error in subsequent xray claim, that would be considered out of sample. We had a question on why we stratify our sample, the size really impacts the claim process egg processes utilized. The large claims have more control in place. You have administrators doing predisbursement audit and doing claim reveals and medical necessity reviews. The lower dollars are automated with the processes. We find that the side of the claim there are different characteristics as a result of the size of the claim. So we felt like we needed to break out and look at payment thresholds. That is why we needed to stratify the different claims in processing and we ....
Score. If you have a diabetic on the outpatient setting. They are totally counted. If you have a diabetic who is not managed well and goes into hospital you give them a higher risk score because i hate to say sounds like what you are rewarding is poor medical management. If you have a chronic diabetic that comes to the hospital, they come up as a higher score in the concurrent risk score because they went to the hospital. But if they do not end to the hospital on a concurrent basis and they are managed because they are not going to the hospital it lowers the risk point. Thats all im pointing out. Its very important for the audience to understand that if you have two people that are identical being treated in two medical systems and one is getting care that avoids hospitalization they will have a lower risk score. It does not mean in fact that they are less risky and of a less of a diagnosis. We should not read into these scores at least the way you are doing it, a definitive believe to ....
Year, i had a cancer diagnosis, diabetes diagnosis and rb diagnosis. Those are the three diagnosis that were made at the hospital. Your point commissioner is we are not looking at the people who are well managed are and im saying, im repeating your point because we will revisit this issue with red request from the vendors that having a low risk score that you didnt get sent to the hospital. That was well said. That is precisely my point about context and application in this particular case and it needs to be a part of this if we are going to have this discussion annually, then we need to frame kind of why we are doing it, what it is and what the result is because that doesnt communicate year to year. Well walk out here today and i can guarantee you no member of the public or most of this commission will remember exactly what we said on this topic. So we need to talk about points of continuity. Im not talking about the result, im talking about the presentation in this particular case. O ....
Similar results. Its an error rate driven formula. The point is because its an error rate driven formula, there is this size of the overall population would not really matter. I just wanted to make that clear. You need to identify yourself. This is ann fulton with hewitt. Claim audit process. This is a review again from what we reviewed during our audit process. There were questions in our out of sample claim. This is an example, an emergency room claim if we identified an error in subsequent xray claim, that would be considered out of sample. We had a question on why we stratify our sample, the size really impacts the claim process egg processes utilized. The large claims have more control in place. You have administrators doing predisbursement audit and doing claim reveals and medical necessity reviews. The lower dollars are automated with the processes. We find that the side of the claim there are different characteristics as a result of the size of the claim. So we felt like we nee ....