Common use of Discovery Sample Clause in Contracts

Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims for services rendered by CCH of New York (Discovery Sample). The Paid Claims shall be randomly selected in proportion to the total volume of Paid Claims in the Population accounted for by each of CCH of New York’s branch offices. The Paid Claims shall be reviewed based on the supporting documentation available at CCH’s office(s) or under CCH’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, CCH should, as appropriate, further analyze any errors identified in the Discovery Sample. CCH recognizes that OIG or another 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.)