Common use of Quantitative Results Clause in Contracts

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. i. Total number and percentage of instances in which the Billing IRO determined that the Paid Claims submitted by LHC Parkland (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCParkland. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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 Billing IRO), correct allowed amount (as determined by the Billing IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. I. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC RMC (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCRMC. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. a) Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC Provider (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. II. b) 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 LHCProvider. III. c) Total dollar amount of all Overpayments in the sampleSample (if applicable). IV. d) Total dollar amount of Paid Claims included in the sample Sample and the net Overpayment associated with the sampleSample. V. Error Rate in the sample. VI. A spreadsheet of the e) Claims Review results data in a form and format acceptable to OMIG 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.), date of original payment, 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. The Claims Review data may also include other Paid Claim information as defined by OMIG.

Quantitative Results. I. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC Hill-Rom (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCHill- Rom. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC OFX (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCOrthofix. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC ▇▇▇▇▇-JCA (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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▇▇▇▇▇- JCA. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. A spreadsheet of the Quarterly Claims Review 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 (e.g.submitted, DRG, CPT code, etc.), 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. 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. IIii. 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 LHCHarmony-▇▇▇▇▇▇. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC Maxim (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCMaxim. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC Ensign Group (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCEnsign Group. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. A spreadsheet of the Claims MDS 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC the CareAll Entities (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCthe CareAll Entities. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC Kai Heart (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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 LHCKai Heart. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by LHC ▇▇▇▇▇▇▇ Lutheran (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. IIii. 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▇▇▇▇▇▇▇ Lutheran. IIIiii. Total dollar amount of all Overpayments in the sample. IViv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. V. v. Error Rate in the sample. VIvi. A spreadsheet of the Claims MDS 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.)submitted, 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.