Common use of Full Sample Clause in Contracts

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greater, the Billing IRO shall select an additional sample of Paid Claims (Full Sample) in that Strata using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland or under Parkland’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the Billing IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papers) received from Parkland to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greaternecessary, as determined by procedures set forth in Section A.4a above, the Billing IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) in that Strata using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland LHC or under ParklandLHC’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, medical record documentation supports homebound status and reimbursedthe medical necessity of the home health services furnished. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the Billing IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papersworkpapers) received from Parkland LHC to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greater, the Billing IRO shall select an additional sample of Paid Claims (Full Sample) in that Strata using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual net Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland Hill-Rom or under ParklandHill-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. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the Billing IRO selects the Full Sample Paid Claims using the seed number number(s) generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papersworkpapers) received from Parkland Hill-Rom to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, DMERC or DMERCDME MAC), for appropriate follow-up by that payor.

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greater, the Billing IRO shall select an additional sample of Paid Claims from each Subject Facility (Full Sample) in that Strata using commonly accepted sampling methodsmethods and conduct a MDS Review on the Full Sample. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland Ensign Group or under ParklandEnsign Group’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the Billing IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papersworkpapers) received from Parkland Ensign Group to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greater, the Billing IRO shall select an additional sample of Paid Claims (Full Sample) in that Strata using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland the CareAll Entities or under Parkland’s the CareAll Entities’ control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the Billing IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papersworkpapers) received from Parkland the CareAll Entities to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If the Discovery Sample indicates that the Error Rate for any Strata is 5% or greaternecessary, as determined by procedures set forth in Section III.E.2.a, the Billing IRO shall select perform an additional sample of Beneficiary Paid Claims (Full Sample) in that Strata using commonly accepted sampling methods. methods and in accordance with Appendix D. The Full Sample shall be designed to: (1i) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2ii) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at Parkland Gambro’s office or under ParklandGambro’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the Billing IRO Gambro may use the Beneficiary Paid Claims sampled as part of the Gambro Healthcare, Inc. Corporate Integrity Agreement Discovery Sample, and the corresponding findings for those 10 Beneficiary Paid ClaimsClaims from each of the Clinics in the Sampling Frame, as part of its Full Sample, if: (1i) statistically appropriate and (2ii) the Billing IRO Gambro selects the Full Sample Paid Claims Items using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related work papersworkpapers) received from Parkland Gambro to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.