Common use of Discovery Sample Clause in Contracts

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.)