Common use of Additional Steps if Error Rate is 5% or Greater Clause in Contracts

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 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 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-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 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 Xxxxx-JCA 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 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 Providers 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 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 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 Quarterly Claims Sample (and any related workpapers) to the appropriate Federal health care program payor for appropriate follow-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 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 Choudhary-Rolla Neurology 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 workpaperswork papers) 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 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 Xxxxx shall be required to repay the point estimate of the extrapolated Overpayment in accordance with Section EG, 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-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 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 MBPC 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-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.