Discovery Samples Sample Clauses

Discovery Samples. The IRO shall conduct two Discovery Samples, reviewing a total of 200 randomly selected Paid Claims (Discovery Samples). In the first Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Medicare Population. In the second Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Focus State Medicaid Population. In both Discovery Samples the Paid Claims shall be reviewed based on the supporting documentation available at ▇▇▇▇▇▇▇▇’▇ office or under ▇▇▇▇▇▇▇▇’▇ 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 both Discovery Samples 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, ▇▇▇▇▇▇▇▇ should, as appropriate, further analyze any errors identified in the Discovery Samples. ▇▇▇▇▇▇▇▇ 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 Samples or any other segment of the universe.)

Discovery Samples. The IRO shall randomly select eight (8) hospital units where Pediatrix provides neonatal critical and intensive care services. For each of the eight (8) units selected, the IRO shall randomly select thirty (30) Paid Claims for each unit. The IRO shall review the 240 Paid Claims selected for review (30 per unit) to determine whether the claim was correctly coded, submitted, and reimbursed based on the supporting documentation and applicable billing and coding regulations and guidance. i. If the Error Rate (as defined in Appendix B) for the Discovery Sample for any hospital unit is less than 5%, no additional sampling is required for that hospital unit, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Pediatrix should, as appropriate, further analyze any errors identified in the Discovery Sample. Pediatrix 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.) Pediatrix Medical Group, Inc. Corporate Integrity Agreement ii. If the Discovery Sample indicates that the Error Rate is 5% or greater for any one hospital unit, the IRO shall perform a Full Sample and a Systems Review for that hospital unit, as described below.

Discovery Samples. The IRO shall randomly select and review a sample of 100 Paid Claims from Acute Care (Acute Care Discovery Sample) and 50 Paid Claims from Post-Acute Care (Post-Acute Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation (available at Sound’s office, at the contracted treating hospitals and post acute care facilities, and/or under Sound’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 a 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, Sound should, as appropriate, further analyze any errors identified in a Discovery Sample. Sound 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 a Discovery Sample or any other segment of the universe.)

Discovery Samples. The IRO shall randomly select and review a sample of 50 Paid Claims each from LWCIT and LWCCA.

Discovery Samples. The IRO shall randomly select and review a sample of 50 Paid Claims for one of the two Baptist hospitals (BHMC-NLR or BHMC- LR) in each reporting year (Discovery Sample). In the first reporting year, the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. In the second reporting year, the IRO shall randomly select and review the Discovery Sample from BHMC-LR. In the third reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. In the fourth reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-LR. In the fifth reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. The Paid Claims shall be reviewed based on the supporting documentation available at Baptist’s office or under Baptist’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 any 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, Baptist should, as appropriate, further analyze any errors identified in each Discovery Samples. Baptist 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 each Discovery Sample or any other segment of the universe.)

Discovery Samples. At the end of each Reporting Period, the IRO shall select a statistically valid random sample of six Pharmacies from the Pharmacy Population. For each Selected Pharmacy, the IRO shall select a statistically valid random sample of 100 Prescriptions from the Prescription Population (Discovery Sample). The IRO shall review whether the Schedule II Controlled Substances were dispensed in accordance with applicable provisions of the Controlled Substances Act, state statutes, and federal and state regulations and guidance, based on the supporting documentation available at the Selected Pharmacy. If the Error Rate (as defined above) for a 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, PharMerica should, as appropriate, further analyze any errors identified in the Discovery Samples. PharMerica 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 Prescription included, or errors identified, in the Discovery Samples or any other segment of the universe.)

Discovery Samples. For each Office Set, the IRO shall randomly select and review a sample of 60 Paid Claims selected from the aggregate population of Paid Claims for that Office Set’s Discovery Sample. The Paid Claims shall be reviewed based on the supporting documentation available at Maxim’s office or under Maxim’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 a Discovery Sample is less than 5%, no additional sampling is required, nor is a Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Maxim should, as appropriate, further analyze any errors identified in any Discovery Sample. Maxim 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 any Discovery Sample or any other segment of the universe.)