Discovery Sample. The IRO shall randomly select and review a sample of 50 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at RMC’s office or under RMC’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. Rural/Metro Corporation Corporate Integrity Agreement Appendix B If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, RMC should, as appropriate, further analyze any errors identified in the Discovery Sample. RMC recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 50 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based Alliance/Active/Xxxxx/Xxxx/Xxxxxx Corporate Integrity Agreement- Appendix B on the supporting documentation available at the Provider’s office or under Provider’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, the Provider should, as appropriate, further analyze any errors identified in the Discovery Sample. The Provider recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall select and review a Discovery Sample of Medicare beneficiaries as described below in Sections 3 and 4. The medical records for the Medicare beneficiaries selected shall be reviewed based on the supporting documentation available at Good Shepherd’s offices or under Good Shepherd’s control and applicable billing and coding regulations and guidance to determine whether the beneficiary was eligible for the hospice benefit and whether all claims for hospice services furnished to the beneficiary were correctly coded, submitted, and reimbursed.
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at La Fuente’s office or under La Fuente’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Xx Xxxxxx should, as appropriate, further analyze any errors identified in the Discovery Sample. La Fuente recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on: (i) the supporting documentation available at Rehab’s office or under Rehab’s control; (ii) appropriate contacts by the IRO with ordering physicians and Rehab customers and/or caregivers of Rehab customers; and (iii) applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. Among the issues to be reviewed are: (i) whether the power wheelchairs and accessories were correctly coded, submitted, billed to Federal health care programs appropriately; (ii) whether Rehab maintained in its records documentation of all supporting documentation described in 42 C.F.R. § 410.38(c); and (iii) whether Rehab’s documentation mirrors the documentation the ordering physician’s documentation. At least 25 claims in the Discovery Sample shall include a review of whether Rehab’s documentation mirrors the documentation of the ordering physician. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Rehab should, as appropriate, further analyze any errors identified in the Discovery Sample. Rehab recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at Provider’s office or under Provider’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Provider should, as appropriate, further analyze any errors identified in the Discovery Sample. Provider recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of a minimum of 50 Paid Claims, consisting of a minimum of 25 Group 2 claims and a minimum of 25 Group 3 claims. (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at Hill-Rom’s office or under Hill-Rom’s control or, to the extent allowed by applicable Medicare coverage and documentation requirements, to which Hill-Rom has access and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Hill-Rom should, as appropriate, further analyze any errors identified in the Discovery Sample. Hill-Rom recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (each constituting a “Discovery Sample”) at each Dignity Health Covered Facility selected for review. The Paid Claims shall be reviewed based on the supporting documentation available at Dignity Health’s office or under Dignity Health’s control and applicable billing and coding regulations and guidance to determine whether the services were medically necessary, and the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample for any Dignity Health Covered Facility is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Dignity Health shall, as appropriate, further analyze any errors identified in the Discovery Sample. Dignity Health recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 50 Paid Claims (each constituting a “Discovery Sample”) at each CHSI Covered Facility selected for review. The Paid Claims shall be reviewed based on the supporting documentation available at CHSI’s office or under CHSI’s control and applicable billing and coding, regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. Community Health Systems, Inc. 2 Corporate Integrity Agreement - Appendix B If the Error Rate (as defined above) for any Discovery Sample for any CHSI Covered Facility is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, CHSI should, as appropriate, further analyze any errors identified in the Discovery Sample. CHSI recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at CareMed’s office or under CareMed’s control, (including but not limited to, an electronic or hard copy of the prescription, proof of delivery of the prescription, and any documentation relating to prior authorizations required by the payor for the prescription), applicable billing regulations and guidance, and Part D plan payment provisions to determine whether the claim was correctly submitted and reimbursed. For each Paid Claim reviewed, the IRO should verify that CareMed maintained documentation of (1) the prescription or order for the drug, item, or supply dispensed; (2) the delivery of the drug, item, or supply; and (3) any required preauthorization. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, CareMed should, as appropriate, further analyze any errors identified in the Discovery Sample. CareMed recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
