Quantitative Results Sample Clauses

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Progenity differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Progenity. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to Progenity. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that did not have appropriate documentation of medical necessity and resulted in an Overpayment to Progenity. iv. Total dollar amount of all Overpayments in the Claims Review Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample. vi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Xxxxx (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Xxxxx. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Quarterly Claims Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Signature differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Signature. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to Signature. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to Signature. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to Signature. v. Total dollar amount of all Overpayments in the Claim Review Sample, if any. vi. Total dollar amount of Paid Claims in the Claims Review Sample, if any. vii. Error Rate in the Claims Review Sample, if any. The Error Rate shall be calculated by dividing the Overpayment in Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid Claims: the Federal health care program billed; beneficiary health insurance claim number, dates of service, code submitted (e.g., PDPM or RUG code), code reimbursed, allowed amount by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. I. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. II. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to LHC. III. Total dollar amount of all Overpayments in the sample. IV. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. Error Rate in the sample. VI. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by the CareAll Entities (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to the CareAll Entities. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Rehab. iii. Total dollar amount of all Overpayments in the Discovery Sample and the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. v. Error Rate in the Discovery Sample and the Full Sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.

Quantitative Results. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Extendicare (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by or on behalf of CCH of New York (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to CCH of New York. iii. Total dollar amount of all Overpayments in the Discovery Sample and the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. v. Error Rate in the Discovery Sample and the Full Sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), and the dollar difference between the allowed amount reimbursed by the payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Xxxxxxxxxx was improperly coded, submitted, reimbursed, or was not medically necessary or appropriate (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Xxxxxxxxxx. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Quarterly Claims Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, type of cardiac procedure provided, whether the procedure was medically necessary and appropriate, allowed amount reimbursed by payor, correct procedure code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CHN differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample. v. Error Rate in the Claims Review Sample.