Discovery Sample. The IRO shall randomly select and review a sample of 50 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at RMC’s office or under RMC’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. Rural/Metro Corporation Corporate Integrity Agreement Appendix B If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, RMC should, as appropriate, further analyze any errors identified in the Discovery Sample. RMC recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 50 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based Alliance/Active/Xxxxx/Xxxx/Xxxxxx Corporate Integrity Agreement- Appendix B on the supporting documentation available at the Provider’s office or under Provider’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, the Provider should, as appropriate, further analyze any errors identified in the Discovery Sample. The Provider recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall select and review a Discovery Sample of Medicare beneficiaries as described below in Sections 3 and 4. The medical records for the Medicare beneficiaries selected shall be reviewed based on the supporting documentation available at Good Shepherd’s offices or under Good Shepherd’s control and applicable billing and coding regulations and guidance to determine whether the beneficiary was eligible for the hospice benefit and whether all claims for hospice services furnished to the beneficiary were correctly coded, submitted, and reimbursed.
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on: (i) the supporting documentation available at Orbit’s office or under Orbit’s control; (ii) appropriate contacts by the IRO with ordering physicians and Orbit customers and/or caregivers of Orbit customers; and (iii) applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. Among the issues to be reviewed are: (i) whether the power wheelchairs and accessories were correctly coded, submitted, billed to Federal health care programs appropriately; (ii) whether Orbit maintained in its records documentation of all supporting documentation described in 42 C.F.R. § 410.38(c); and (iii) whether Orbit’s documentation mirrors the documentation the ordering physician’s documentation. At least 25 claims in the Discovery Sample shall include a review of whether Orbit’s documentation mirrors the documentation of the ordering physician. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Orbit should, as appropriate, further analyze any errors identified in the Discovery Sample. Orbit recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of fifty (50) Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at PALMS’s office or under PALMS’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, PALMS should, as appropriate, further analyze any errors identified in the Discovery Sample. PALMS recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at the Providers’ office or under the Providers’ control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, the Providers should, as appropriate, further analyze any errors identified in the Discovery Sample. The Providers recognize that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at Medicus’s office or under Medicus’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Medicus should, as appropriate, further analyze any errors identified in the Discovery Sample. Medicus recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The IRO shall randomly select and review a sample of a minimum of 50 Paid Claims, consisting of a minimum of 25 Group 2 claims and a minimum of 25 Group 3 claims. (Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation available at Hill-Rom’s office or under Hill-Rom’s control or, to the extent allowed by applicable Medicare coverage and documentation requirements, to which Hill-Rom has access and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Hill-Rom should, as appropriate, further analyze any errors identified in the Discovery Sample. Hill-Rom recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
Discovery Sample. The Billing IRO shall randomly select and review a sample of 200 Paid Claims (Discovery Sample) each
Discovery Sample. The IRO shall randomly select and review a sample of 100 Paid Claims for services rendered by CCH of New York (Discovery Sample). The Paid Claims shall be randomly selected in proportion to the total volume of Paid Claims in the Population accounted for by each of CCH of New York’s branch offices. The Paid Claims shall be reviewed based on the supporting documentation available at CCH’s office(s) or under CCH’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for the Discovery Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, CCH should, as appropriate, further analyze any errors identified in the Discovery Sample. CCH recognizes that OIG or another HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Sample or any other segment of the universe.)
