MCCG definition
Examples of MCCG in a sentence
The IRO shall request all documentation and materials required for its review of the Paid Claims selected as part of the Discovery Sample or Full Sample (if applicable), and MCCG shall furnish such documentation and materials to the IRO prior to the IRO initiating its review of the Discovery Sample or Full Sample (if applicable).
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 MCCG.
MCCG shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor.
Accordingly, MCCG shall, as appropriate, further analyze any errors identified in the Discovery Sample.
Absent notification from OIG that the IRO is unacceptable, MCCG may continue to engage the IRO.
OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from MCCG to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.
Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by MCCG (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
OIG will attempt in good faith to resolve any Claims Review or Inpatient Medical Necessity and Appropriateness Review issues with MCCG prior to conducting a Validation Review.
If not yet quantified, within 60 days after identification, MCCG shall notify the payor of its efforts to quantify the Overpayment amount along with a schedule of when such work is expected to be completed.
OIG may agree to a suspension of MCCG’s obligations under this CIA based on a certification by MCCG that it is no longer providing health care items or services that will be billed to any Federal health care program and that it does not have any ownership or control interest, as defined in 42 U.S.C. §1320a-3, in any entity that bills any Federal health care program.