Additional Steps if Error Rate is 5% or Greater Sample Clauses

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.
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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. Xxxxxxxxxx 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.
Sample 1
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.
Sample 1

Related to Additional Steps if Error Rate is 5% or Greater

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  • Regulatory Event New Taxes If, after the Effective Date, a Regulatory Event occurs or New Taxes are imposed, and such event or taxes have a direct, material and adverse effect on the economic benefits to a Party of this ESA, the affected Party shall send written notice to the other Party, setting forth the Regulatory Event or New Taxes and reasonably demonstrating the effect of the same on the affected Party. Upon delivery of such notice, the Parties shall use reasonable efforts to negotiate an amendment to this ESA to mitigate such effect. Alternatively, if as a direct result of such a Regulatory Event or New Taxes, the Competitive Supplier incurs additional, material costs, the Competitive Supplier shall provide a written notice to the Town that documents: a) the effective date of the Regulatory Event or New Taxes; b) a detailed explanation and reasonable demonstration of the material costs incurred as a result of the Regulatory Event or New Taxes; c) the timing of the cost impact to be incurred by the Competitive Supplier; d) the proposed price increase per kWh to be passed on to Participating Consumers; and e) a proposed plan for coordinating with the Local Distributor for an increase in the price per kWh that is billed by the Local Distributor, designed to reimburse the Competitive Supplier for such cost impact. If the Town and the Competitive supplier cannot agree on the amendment to this ESA or reimbursement contemplated by this section, the matter may be subject to dispute resolution in accordance with section 12.2. In no event shall a price change become effective without providing Participating Consumers with a 30-day advance notice of the price change.

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  • Reportable Events Involving the Xxxxx Law Notwithstanding the reporting requirements outlined above, any Reportable Event that involves solely a probable violation of section 1877 of the Social Security Act, 42 U.S.C. §1395nn (the Xxxxx Law) should be submitted by Practitioner to CMS through the self-referral disclosure protocol (SRDP), with a copy to the OIG. If Practitioner identifies a probable violation of the Xxxxx Law and repays the applicable Overpayment directly to the CMS contractor, then Practitioner is not required by this Section III.G to submit the Reportable Event to CMS through the SRDP.

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