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 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.