Common use of Full Sample Clause in Contracts

Full Sample. If the Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) 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 ▇▇. ▇▇▇▇▇▇▇▇’▇ office or under ▇▇. ▇▇▇▇▇▇▇▇’▇ control and applicable billing and coding regulations and guidance to determine whether the claim submitted 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 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 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 workpapers) received from ▇▇. ▇▇▇▇▇▇▇▇ 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 is 5% or greaternecessary, as determined by procedures set forth in Section III.D.2.a, the IRO shall select perform an additional sample of Paid Claims (Full Sample) using commonly accepted sampling methods. methods and in accordance with Appendix B. 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 ▇▇. ▇▇▇▇▇▇▇▇’▇ PolyMedica's office or under ▇▇. ▇▇▇▇▇▇▇▇’▇ PolyMedica's control and applicable billing and coding regulations and guidance to determine whether the claim submitted 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 IRO PolyMedica may use the Paid Claims Items sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims50 Items, as part of its Full Sample, if: (1i) statistically appropriate and (2ii) the IRO PolyMedica selects the Full Sample Paid Claims Items using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer POLYMEDICA CORPORATE INTEGRITY AGREEMENT the findings of the Full Sample (and any related workpapers) received from ▇▇. ▇▇▇▇▇▇▇▇ PolyMedica 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.