Common use of Audits and Recovery Clause in Contracts

Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records to determine, but not necessarily limited to, verification of services provided, length of stay, Medical Necessity of services provided, and the appropriateness of procedure/revenue codes reported to BCBSM and to obtain recoveries based on such audits as set forth in Addendum F.

Appears in 2 contracts

Samples: Traditional Participation Agreement, Traditional Participation Agreement

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Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information information, and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records to determinedetermine program compliance. This includes, but is not necessarily limited to, verification of services provided, length of stayadherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure/revenue procedure codes reported to BCBSM BCBSM, and to obtain recoveries based on such audits as set forth in Addendum F.G.

Appears in 1 contract

Samples: Skilled Nursing Facility Participation Agreement

Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information information, and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records to determinedetermine program compliance. Such audits include, but are not necessarily limited to, verification of services provided, length of stayadherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure/revenue codes reported to BCBSM. BCBSM and is entitled to obtain recoveries based on such audits as set forth in Addendum F.H.

Appears in 1 contract

Samples: End Stage Renal Disease Facility Participation Agreement

Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information information, and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records for all Approved Sites to determinedetermine program compliance. Such audits include, but are not necessarily limited to, verification of services provided, length of stayadherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure/revenue codes reported to BCBSM. BCBSM and is entitled to obtain recoveries based on such audits as set forth in Addendum F.H.

Appears in 1 contract

Samples: Hospice Provider Participation Agreement

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Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information information, and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records to determinedetermine program compliance. Such audits include, but are not necessarily limited to, verification of services provided, length of stayadherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure/revenue codes reported to BCBSM. BCBSM and is entitled to obtain recoveries based on such audits as set forth described in Addendum F.H.

Appears in 1 contract

Samples: End Stage Renal Disease Facility Network Affiliation Agreement

Audits and Recovery. Subject to all applicable laws regarding confidentiality of patient specific information information, and the confidentiality provisions set forth in this Agreement, Facility agrees that BCBSM may photocopy, review and audit Facility's records to determinedetermine program compliance. This includes, but is not necessarily limited to, verification of services provided, length of stayverification that services were provided at an Approved Site, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of levels of care (tiers) or procedure/revenue billing codes reported to BCBSM. BCBSM and is entitled to obtain recoveries based on such audits as set forth in Addendum F.this Agreement.

Appears in 1 contract

Samples: Long Term Acute Care Hospital Participation Agreement

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