Common use of Discovery Sample 1 Clause in Contracts

Discovery Sample 1. For each Reporting Period, the IRO shall randomly select and review a sample of 100 Paid Claims for which the Friendship Entities have received reimbursement from the Medicare program (Discovery Sample 1). The Paid Claims shall be reviewed based on the supporting documentation available at the Friendship Entities’ office or under the Friendship Entities’ 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 Discovery Sample 1 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 Friendship Entities should, as appropriate, further analyze any errors identified in Discovery Sample 1. The Friendship Entities recognize 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 Discovery Sample 1 or any other segment of the universe.)