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 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab 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 RehabCCH 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 Rehab the Friendship 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 Rehabthe Friendship Entities. iii. Total dollar amount of all Overpayments in the Discovery Sample Samples and the Full Sample Samples (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample Samples and the Full Sample Samples and the net Overpayment associated with the Discovery Sample Samples and the Full SampleSamples. v. Error Rate in the Discovery Sample Samples and the Full SampleSamples. 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 any Full Sample is Samples are 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 Rehab Dignity Health (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 RehabDignity Health. 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 Inpatient Medical Necessity and Appropriateness 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab CHSI (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 RehabCHSI. 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 Inpatient Medical Necessity and Appropriateness 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab 21st Century (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 Rehab21st Century. iii. Total dollar amount of all Overpayments in the each Discovery Sample and the Full Sample Samples (if applicable). iv. Total dollar amount of Paid Claims included in the each Discovery Sample and the Full Sample Sample, and the net Overpayment associated with the Discovery Sample Samples and the Full SampleSamples. v. Error Rate in the each 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. 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 Samples and the Full Sample Sample(s) (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample Samples and the Full Sample Sample(s) and the net Overpayment associated with the Discovery Sample Samples and the Full SampleSample(s). v. Error Rate in the Discovery Sample Samples and the Full SampleSample(s). 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. ‌‌ i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab Toccoa (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 RehabToccoa. iii. Total dollar amount of all Overpayments in the Discovery Sample Samples and the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample Samples and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample.Sample.‌ v. Error Rate in the Discovery Sample Samples and the Full Sample.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.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 Rehab Trans-Star (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 RehabTrans- Star. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab the DIG 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 Rehabthe DIG Entities. 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab the Providers (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 Rehabthe Providers. 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, Medicaid managed care organization 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. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rehab USPh (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 RehabUSPh. iii. Total dollar amount of all Overpayments in the Discovery Sample Samples and the Full Sample Samples (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Sample Samples and the Full Sample Samples and the net Overpayment associated with the Discovery Sample Samples and the Full SampleSamples. v. Error Rate in the Discovery Sample Samples and the Full SampleSamples. 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 any Full Sample is Samples are performed, the methodology used by the IRO to estimate the actual Overpayment in the Population 1 or Population 2 (on a per-Clinic basis) and the amount of such Overpayment.