Common use of Recommendations Clause in Contracts

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s billing and coding system or to MPG’s controls for ensuring that all items and services billed to Medicare, a state Medicaid program, or TRICARE are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇. ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇. ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇. ▇▇▇ and Interventional Cardiology’s billing and coding system or to MPG▇▇. ▇▇▇ and Interventional Cardiology’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s the Covered Entities’ billing and coding system or to MPG’s the Covered Entities’ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS’s billing and coding system or to MPG▇▇. ▇▇▇▇▇▇▇▇▇▇-AFAS’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGProvider’s billing and coding system or to MPGProvider’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇▇▇▇▇ Valley’s billing and coding system or to MPG▇▇▇▇▇▇ Valley’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and necessary, appropriately documented, and any wavier of cost-sharing amounts are appropriate, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGEPIPG’s billing and coding system or to MPGEPIPG’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s 's report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇ Pharmacy's billing and coding system or to MPG’s ▇▇▇▇▇ Pharmacy's controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The Claims Review IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇▇’ billing and coding system or to MPG’s ▇▇▇▇▇▇▇’ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C.’s billing and coding system or to MPG▇▇. ▇▇▇▇▇▇▇▇ and Fleckner, P.C.’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇’▇ billing and coding system or to MPGNorman’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary necessary, properly supervised, and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGTHM’s billing and coding system or to MPGTHM’s controls for ensuring that all items and services billed to Medicare, a state Medicaid program, program or TRICARE Medicaid managed care program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGDLDC’s billing and coding system or to MPGDLDC’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary necessary, medically appropriate, and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGthe Practice’s billing and coding system or to MPGthe Practice’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE are program are‌‌ medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇▇▇▇, Integrated, Golden Management or any Covered Entity’s billing and coding system or to MPG’s their controls for ensuring that all items and services billed to Medicare, a Medicare Managed Care, state Medicaid, and Medicaid program, or TRICARE Managed Care program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s OC and ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s OC and ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, a Medicare and state Medicaid program, or TRICARE programs are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇▇▇▇▇’s billing and coding system or to MPG▇▇▇▇▇▇’s controls for ensuring that all items and services billed to Medicarethe Medicare program by ▇▇▇▇▇▇ are correctly coded, a state Medicaid program, or TRICARE are medically necessary and appropriately documented, and medically necessary, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇. ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇. ▇▇▇▇▇▇’▇ controls for ensuring that all (i) items and services billed to Medicarethe Medicare program by ▇▇. ▇▇▇▇▇▇ are correctly coded, a state Medicaid programappropriately documented, or TRICARE and medically necessary; and (ii) medications prescribed by ▇▇. ▇▇▇▇▇▇ are medically necessary and appropriately documentednecessary, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇ ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇▇▇▇▇▇-▇▇▇▇▇▇▇ ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, a state Medicaid program, or TRICARE Federal health care programs are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇. ▇▇▇▇▇▇-▇▇▇▇▇▇ D.P.M.’s billing and coding system or to MPG▇▇. ▇▇▇▇▇▇-▇▇▇▇▇▇ D.P.M.’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇. ▇▇▇▇▇’▇ billing and coding system or to MPG’s ▇▇. ▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicarethe Medicare program by ▇▇. ▇▇▇▇▇ are correctly coded, a state Medicaid program, or TRICARE are medically necessary and appropriately documented, and medically necessary, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s ▇▇▇▇▇▇▇’▇ billing and coding system system, including requirements relating to the collection or waiver of copayment and other cost-sharing amounts, or to MPG’s ▇▇▇▇▇▇▇’▇ controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and necessary, appropriately documented, and the copayments and other cost-sharing amounts are collected or waived in accordance with applicable payor requirements based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGAlign’s billing and coding system or to MPGAlign’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇▇▇▇▇▇▇ Clinic’s billing and coding system or to MPG▇▇▇▇▇▇▇▇ Clinic’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGGonzaga’s billing and coding system or to MPGGonzaga’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s the billing and coding system used to submit claims by or on behalf of ▇▇▇▇▇▇▇ USD Medical Center or to MPG’s the controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, program by or TRICARE on behalf of ▇▇▇▇▇▇▇ USD Medical Center are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG▇▇▇▇ Clinic’s billing and coding system or to MPG▇▇▇▇ Clinic’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌Review.

Recommendations. The IRO’s report shall include any recommendations for improvements to MPG’s the billing and coding system system(s) for ▇▇. ▇▇▇▇▇ or the Cancer Centers or to MPG’s controls maintained by ▇▇. ▇▇▇▇▇ and the Cancer Centers for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGPractitioner’s billing and coding system or to MPGPractitioner’s controls for ensuring that all items and services billed to Medicare, Medicare or a state Medicaid program, or TRICARE program are medically necessary and appropriately documented, based on the findings of the Quarterly Claims Review.‌‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGPractitioner’s billing and coding system or to MPGPractitioner’s controls for ensuring that all items and services billed to Medicarethe Medicare program by Practitioner are correctly coded, a state Medicaid program, or TRICARE are medically necessary and appropriately documented, and medically necessary, based on the findings of the Quarterly Claims Review.‌‌Review.‌

Recommendations. The IRO’s report shall include any recommendations for improvements to MPGProvider’s billing and coding system or to MPGProvider’s controls for ensuring that all items and services billed to Medicarethe Medicare program by Provider are correctly coded, a state Medicaid program, or TRICARE are medically necessary and appropriately documented, and medically necessary, based on the findings of the Quarterly Claims Review.‌‌