Additional Steps if Error Rate is 5% or Greater. If the Error Rate (as defined above) for any Quarterly Claims Review performed is 5% or greater, the IRO will estimate the actual Overpayment in the Population for that three-month period by identifying the point estimate. To identify the point estimate, the IRO shall extrapolate the Error Rate as determined in the Quarterly Claims Sample to the Population for the applicable Quarterly Claims Review. The group practice shall be required to repay the point estimate of the extrapolated Overpayment in accordance with Section E, below. OIG, in its sole discretion, may refer the findings of the Quarterly Claims Sample (and any related workpapers) to the appropriate Federal health care program payor for appropriate follow-up by that payor. The Quarterly Claims Review Report prepared by the IRO shall indicate the extrapolated Overpayment amount and the methodology used by the IRO to determine the extrapolated Overpayment amount.
Additional Steps if Error Rate is 5% or Greater. If the Error Rate (as defined above) for any Quarterly Claims and Cardiac Procedures Review performed is 5% or greater, the IRO will estimate the actual Overpayment in the Population for that three-month period by identifying the point estimate. To identify the point estimate, the IRO shall extrapolate the Error Rate as determined in the Quarterly Claims Sample to the Population for the applicable Quarterly Claims and Cardiac Procedures Review. Xxxxx shall be required to repay the point estimate of the extrapolated Overpayment in accordance with Section E, below. OIG, in its sole discretion, may refer the findings of the Quarterly Claims Sample (and any related workpapers) to the appropriate Federal health care program payor for appropriate follow-up by that payor. The Quarterly Claims and Cardiac Procedures Review Report prepared by the IRO shall indicate the extrapolated Overpayment amount and the methodology used by the IRO to determine the extrapolated Overpayment amount.
Additional Steps if Error Rate is 5% or Greater. If the Error Rate (as defined above) for any Dialysis Access Procedures Review performed is 5% or greater, the IRO will estimate the actual Overpayment in the Population for that Reporting Period by identifying the point estimate. To identify the point estimate, the IRO shall extrapolate the Error Rate as determined in the Dialysis Access Procedures Sample to the Dialysis Access Procedures Population for the applicable Dialysis Access Procedures Review. Xxx shall be required to repay the point estimate of the extrapolated Overpayment in accordance with Section E, below. OIG, in its sole discretion, may refer the findings of the Dialysis Access Procedures Review (and any related workpapers) to the appropriate Federal health care program payor for appropriate follow-up by that payor. The Dialysis Access Procedures Review Report prepared by the IRO shall indicate the extrapolated Overpayment amount and the methodology used by the IRO to determine the extrapolated Overpayment amount.
