Chart Review Sample Sample Clauses

Chart Review Sample. The IRO shall randomly select a sample of 100 Risk Adjusted Members (Chart Review Sample) from the Population. The Diagnosis Data and the Medical Records associated with the Chart Review Sample and available at ▇▇▇▇▇▇’▇ office or under ▇▇▇▇▇▇’▇ control shall be reviewed to determine whether the Diagnosis Data is supported by the Medical Records and correctly documented and coded, e.g., in accordance with ICD-9/10 coding guidelines.‌
View Source
Chart Review Sample. The IRO shall randomly select a sample of 100 Risk Adjusted Members (Chart Review Sample) from the Population. The Diagnosis Data and the Medical Records associated with the Chart Review Sample and available at BMG’s office or under BMG’s control shall be reviewed to determine whether the Diagnosis‌ Data is supported by the Medical Records and correctly documented and coded, e.g., in accordance with ICD-9/10 coding guidelines.‌ a. The OIG may limit the Population to Risk Adjusted Members with specific HCCs or to Risk Adjusted Members who received care or treatment by particular BMG physician(s), or using other factors determined by the OIG in its discretion. In the event that OIG exercises its discretion to limit the Population, OIG shall notify BMG at least 60 days prior to the end of the Reporting Period of any information needed from BMG in order for the OIG to identify the Population. The OIG shall notify BMG and its IRO of the subset of the Population to be reviewed at least 30 days prior to the end of the Reporting Period.‌ b. For any Risk Adjusting Diagnosis in the Chart Review Sample that is not supported by the Medical Record or documented and coded correctly (collectively, Unsupported Diagnosis), the IRO shall identify any correction to the Diagnosis Data and the basis for the IRO’s determination that the Risk Adjusting Diagnosis was not appropriately documented and coded or supported by the Medical Record, review the controls for ensuring that each Risk Adjusting Diagnosis submitted to a Medicare Advantage plan is appropriately documented and coded, review the system(s) and process(es) (e.g., improper use of an electronic problem list) that generated the Unsupported Diagnosis and identify any problems or weaknesses that may have resulted in the Unsupported Diagnosis. The IRO shall provide its observations and recommendations on suggested improvements to the system(s), process(es) and controls relating to the Unsupported Diagnosis.‌
View Source

Related to Chart Review Sample

  • Project Review A. Programmatic Allowances 1. If FEMA determines that the entire scope of an Undertaking conforms to one or more allowances in Appendix B of this Agreement, with determinations for Tier II Allowances being made by SOI-qualified staff, FEMA shall complete the Section 106 review process by documenting this determination in the project file, without SHPO review or notification. 2. If the Undertaking involves a National Historic Landmark (NHL), FEMA shall notify the SHPO, participating Tribe(s), and the NPS NHL Program Manager of the NPS Midwest Regional Office that the Undertaking conforms to one or more allowances. FEMA shall provide information about the proposed scope of work for the Undertaking and the allowance(s) enabling FEMA’s determination. 3. If FEMA determines any portion of an Undertaking’s scope of work does not conform to one or more allowances listed in Appendix B, FEMA shall conduct expedited or standard Section 106 review, as appropriate, for the entire Undertaking in accordance with Stipulation II.B, Expedited Review for Emergency Undertakings, or Stipulation II.C, Standard Project Review. 4. Allowances may be revised and new allowances may be added to this Agreement in accordance with Stipulation IV.A.3, Amendments. B. Expedited Review for Emergency Undertakings

  • Post Review With respect to each contract not governed by paragraph 2 of this Part, the procedures set forth in paragraph 4 of Appendix 1 to the Guidelines shall apply.

  • Contract Review Agent shall have reviewed all material contracts of Borrowers including, without limitation, leases, union contracts, labor contracts, vendor supply contracts, license agreements and distributorship agreements and such contracts and agreements shall be satisfactory in all respects to Agent;

  • ADB’s Review of Procurement Decisions 11. All contracts procured under international competitive bidding procedures and contracts for consulting services shall be subject to prior review by ADB, unless otherwise agreed between the Borrower and ADB and set forth in the Procurement Plan.

  • Agreement Review If, pursuant to section 25.10 (Review of Agreement) of the Bilateral Agreement, the Bilateral Agreement is reviewed after three or five years, or both, of the effective date of the Bilateral Agreement, and any changes to the Bilateral Agreement are required as a result, the Parties agree to amend the Agreement as necessary and in a manner that is consistent with such changes.