Common use of Discovery Samples Clause in Contracts

Discovery Samples. The IRO shall randomly select a sample of 30 Paid Claims from each of the ten Subject Facilities (Discovery Samples) and conduct the MDS Review (as defined below). The Paid Claims shall be reviewed based on the supporting documentation available at Extendicare’s offices or under Extendicare’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 for that Subject Facility, nor is the MDS Systems Review, required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Extendicare should, as appropriate, further analyze any errors identified in the Discovery Samples. Extendicare 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.)