Common use of Discovery Sample Clause in Contracts

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 100 Paid Claims (Discovery Sample). The Paid Claims shall be reviewed based on: (i) the supporting documentation available at OrbitRehab’s office or under OrbitRehab’s control; (ii) appropriate contacts by the IRO with ordering physicians and Orbit Rehab customers and/or caregivers of Orbit Rehab 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 Rehab maintained in its records documentation of all supporting documentation described in 42 C.F.R. § 410.38(c); and (iii) whether OrbitRehab’s documentation mirrors the documentation the ordering physician’s documentation. At least 25 claims in the Discovery Sample shall include a review of whether OrbitRehab’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 Rehab should, as appropriate, further analyze any errors identified in the Discovery Sample. Orbit Rehab 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.)