Claims and Cardiac Procedures Review Sample Clauses

Claims and Cardiac Procedures Review. The IRO shall conduct a review of (1) the medical necessity and appropriateness of cardiac procedures performed by Xxxxxxxxxx, and (2) Xxxxxxxxxx’x coding, billing, and claims submission to the Federal health care programs and the reimbursement received for procedures performed by Xxxxxxxxxx, for each three-month period during the term of this IA (Quarterly Claims and Cardiac Procedures Review) and shall prepare a Quarterly Claims and Cardiac Procedures Review Report, as outlined in Appendix B to this IA, which is incorporated by reference. The first three-month period for purposes of the Quarterly Claims and Cardiac Procedures Review requirement shall begin 30 days after the Effective Date. Each Quarterly Claims and Cardiac Procedures Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by the Quarterly Claims and Cardiac Procedures Review.
Sample 1
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Claims and Cardiac Procedures Review. The IRO shall conduct the Claims and Cardiac Procedures Review for each three- month period during the term of this IA (Quarterly Claims and Cardiac Procedures Review) and prepare a report for each Quarterly Claims and Cardiac Procedures Review performed. The first three-month period shall begin 30 days following the Effective Date of this IA. For each Claims and Cardiac Procedures Review the IRO shall: evaluate and analyze Xxxxxxxxxx’x Paid Claims (as defined at Section A.1.b below) to determine (1) if each procedure was medically necessary and appropriate under the applicable Federal health care program rules and regulations; and (2) whether the claims submissions by or on behalf of Xxxxxxxxxx to Federal health care programs, and the reimbursement received, associated with each Paid Claim was documented, coded, and billed appropriately.
Sample 1

Related to Claims and Cardiac Procedures Review

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