Discovery Samples Sample Clauses

Discovery Samples. The IRO shall randomly select a sample of 30 Paid Claims from each of the ten Subject Facilities (Discovery Samples) and conduct the MDS Review (as defined below). The Paid Claims shall be reviewed based on the supporting documentation available at Extendicare’s offices or under Extendicare’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for a Discovery Sample is less than 5%, no additional sampling is required for that Subject Facility, nor is the MDS Systems Review, required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Extendicare should, as appropriate, further analyze any errors identified in the Discovery Samples. Extendicare 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 Samples or any other segment of the universe.)
Sample 1Sample 2Sample 3
AutoNDA by SimpleDocs
Discovery Samples. The IRO shall randomly select and review two samples of 100 Paid Claims (Discovery Samples). One Discovery Sample is for Paid Claims drawn from all laboratory claims, and the other Discovery Sample is for Paid Claims drawn from all service lines within which physicians participate in 21st Century’s ancillary bonus pools. The Paid Claims shall be reviewed based on the supporting documentation available at 21st Century’s office or under 21st Century’s control, and the applicable coverage, billing, coding, and medical necessity requirements, regulations, and/or guidance to determine whether the items and services provided were medically necessary, and whether the claims were correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for each 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, 21st Century should, as appropriate, further analyze any errors identified in the Discovery Sample. 21st Century 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 Samples or any other segment of the universe.)
Sample 1
Discovery Samples. At the end of each Reporting Period, the IRO shall select a statistically valid random sample of six Pharmacies from the Pharmacy Population. For each Selected Pharmacy, the IRO shall select a statistically valid random sample of 100 Prescriptions from the Prescription Population (Discovery Sample). The IRO shall review whether the Schedule II Controlled Substances were dispensed in accordance with applicable provisions of the Controlled Substances Act, state statutes, and federal and state regulations and guidance, based on the supporting documentation available at the Selected Pharmacy. If the Error Rate (as defined above) for a 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, PharMerica should, as appropriate, further analyze any errors identified in the Discovery Samples. PharMerica 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 Prescription included, or errors identified, in the Discovery Samples or any other segment of the universe.)
Sample 1
Discovery Samples. The IRO shall conduct two Discovery Samples, reviewing a total of 200 randomly selected Paid Claims (Discovery Samples). In the first Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Medicare Population. In the second Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Focus State Medicaid Population. In both Discovery Samples the Paid Claims shall be reviewed based on the supporting documentation available at Xxxxxxxx’x office or under Xxxxxxxx’x control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for both Discovery Samples 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, Xxxxxxxx should, as appropriate, further analyze any errors identified in the Discovery Samples. Xxxxxxxx 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 Samples or any other segment of the universe.)
Sample 1
Discovery Samples. The IRO shall randomly select and review a sample of 50 Paid Claims each from LWCIT and LWCCA.
Sample 1
Discovery Samples. For each Office Set, the IRO shall randomly select and review a sample of 60 Paid Claims selected from the aggregate population of Paid Claims for that Office Set’s Discovery Sample. The Paid Claims shall be reviewed based on the supporting documentation available at Maxim’s office or under Maxim’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for a Discovery Sample is less than 5%, no additional sampling is required, nor is a Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Maxim should, as appropriate, further analyze any errors identified in any Discovery Sample. Maxim 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 any Discovery Sample or any other segment of the universe.)
Sample 1
Discovery Samples. The IRO shall randomly select eight (8) hospital units where Pediatrix provides neonatal critical and intensive care services. For each of the eight (8) units selected, the IRO shall randomly select thirty (30) Paid Claims for each unit. The IRO shall review the 240 Paid Claims selected for review (30 per unit) to determine whether the claim was correctly coded, submitted, and reimbursed based on the supporting documentation and applicable billing and coding regulations and guidance. i. If the Error Rate (as defined in Appendix B) for the Discovery Sample for any hospital unit is less than 5%, no additional sampling is required for that hospital unit, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, Pediatrix should, as appropriate, further analyze any errors identified in the Discovery Sample. Pediatrix 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.) Pediatrix Medical Group, Inc. Corporate Integrity Agreement ii. If the Discovery Sample indicates that the Error Rate is 5% or greater for any one hospital unit, the IRO shall perform a Full Sample and a Systems Review for that hospital unit, as described below.
Sample 1
AutoNDA by SimpleDocs
Discovery Samples. The IRO shall randomly select and review a sample of 100 Paid Claims from Acute Care (Acute Care Discovery Sample) and 50 Paid Claims from Post-Acute Care (Post-Acute Discovery Sample). The Paid Claims shall be reviewed based on the supporting documentation (available at Sound’s office, at the contracted treating hospitals and post acute care facilities, and/or under Sound’s control), and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for a 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, Sound should, as appropriate, further analyze any errors identified in a Discovery Sample. Sound 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 a Discovery Sample or any other segment of the universe.)
Sample 1
Discovery Samples. The IRO shall randomly select and review a sample of 50 Paid Claims for one of the two Baptist hospitals (BHMC-NLR or BHMC- LR) in each reporting year (Discovery Sample). In the first reporting year, the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. In the second reporting year, the IRO shall randomly select and review the Discovery Sample from BHMC-LR. In the third reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. In the fourth reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-LR. In the fifth reporting year the IRO shall randomly select and review the Discovery Sample from BHMC-NLR. The Paid Claims shall be reviewed based on the supporting documentation available at Baptist’s office or under Baptist’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for any 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, Baptist should, as appropriate, further analyze any errors identified in each Discovery Samples. Baptist 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 each Discovery Sample or any other segment of the universe.)
Sample 1

Related to Discovery Samples

  • SHOP DRAWINGS, PRODUCT DATA AND SAMPLES 4.12.1 Shop Drawings are drawings, diagrams, schedules and other, data specially prepared for the Work by the Contractor or any Subcontractor, manufacturer, supplier or distributor to illustrate some portion of the Work. 4.12.2 Product Data are illustrations, standard schedules, performance charts, instructions, brochures, diagrams and other information furnished by the Contractor to illustrate a material, product or system for some portion of the Work. 4.12.3 Samples are physical examples which illustrate materials, equipment or workmanship and establish standards by which the Work will be judged. 4.12.4 The Contractor shall review, approve and submit, with reasonable promptness and in such sequence as to cause no delay in the Work or in the work of the State or any separate contractor, all Shop Drawings, Product Data and Samples required by the Contract Documents. 4.12.5 By approving and submitting Shop Drawings, Product Data and Samples, the Contractor represents that he / she has determined and verified all materials, field measurements, and field construction criteria related thereto, or will do so, and that he / she has checked and coordinated the information contained within such submittals with the requirements of the Work and of the Contract Documents. 4.12.6 The Contractor shall not be relieved of responsibility for any deviation from the requirements of the Contract Documents by the Architect's approval of Shop Drawings, Product Data or Samples under Subparagraph 2.2.7 of these General Conditions unless the Contractor has specifically informed the Architect and the State in writing of such deviation at the time of sub- mission and the Architect and the State has given written approval to the specific deviation. The Contractor shall not be relieved from responsibility for errors or omissions in the Shop Drawings, Product Data or Samples by the Architect's approval thereof. 4.12.7 The Contractor shall direct specific attention, in writing or on resubmitted Shop Drawings, Product Data or Samples, to revisions other than those requested by the Architect on previous submittals. 4.12.8 No portion of the Work requiring submission of a Shop Drawing, Product Data or Sample shall be commenced until the submittal has been approved by the Architect as provided in Subparagraph 2.2.7 of these General Conditions. All such portions of the Work shall be in accordance with approved submittals.

  • Product Testing No later than [**] prior to a scheduled Delivery ARIAD US shall send to ARIAD SWISSCO the Delivery Documents for review. Following such review, unless within [**] of receipt of the Delivery Documents ARIAD SWISSCO gives written notice of rejection of the Product to be delivered, stating the reasons for such rejection, the Delivery shall proceed, and both Parties shall organize the same. Upon arrival at ARIAD SWISSCO nominated site it shall visually inspect the shipment of the Product to identify any damage to the external packaging. ARIAD SWISSCO may reject any shipment (or portion thereof) of the Product that is damaged by providing to ARIAD US reasonable evidence of damage within [**] after Delivery of such Product. If ARIAD SWISSCO does not so reject any shipment (or portion thereof) of the Product within [**] of Delivery of such Product, ARIAD SWISSCO shall be deemed to have accepted such shipment of the Product; provided, however, that in the case of the Product having any Latent Defect, ARIAD SWISSCO shall notify ARIAD US promptly once it becomes aware that a Product contains a Latent Defect and subsequently may reject such Product by giving written notice to ARIAD US of ARIAD SWISSCO’s rejection of such Product and shipping a representative sample of such Product or other evidence of Non-Conformance to ARIAD US within [**] after becoming aware of such Latent Defect, which notice shall include a description of the Latent Defect.

  • Review of Materials During the term of this Agreement, Client shall ensure that all prospectuses, statements of additional information, registration statements, proxy statements, reports to shareholders, advertising and sales literature or other materials prepared for distribution to Fund shareholders or the public, which refer to the Subadviser in any way, prepared by employees or agents of Client or its affiliates are consistent with information previously provided by Subadviser. Subadviser shall promptly notify the Client of any changes to information pertaining to the Subadviser and stated in the materials described in this Section 6(g).

  • Samples The Contractor shall submit the following samples of Materials and relevant information to the Authority’s Engineer for pre-construction review: (a) manufacturer's test reports and standard samples of manufactured Materials; and (b) samples of such other Materials as the Authority’s Engineer may require.

  • RE-WEIGHING PRODUCT Deliveries are subject to re- weighing at the point of destination by the Authorized User. If shrinkage occurs which exceeds that normally allowable in the trade, the Authorized User shall have the option to require delivery of the difference in quantity or to reduce the payment accordingly. Such option shall be exercised in writing by the Authorized User.

  • API If the Software offers integration capabilities via an API, your use of the API may be subject to additional costs or Sage specific policies and terms and conditions (which shall prevail in relation to your use of the API). You may not access or use the API in any way that could cause damage to us or the Software, or in contravention of any applicable laws. We reserve the right in our sole discretion, to: (i) update any API from time to time; (ii) place limitations around your use of any API; and (iii) deny you access to any API in the event of misuse by you or to otherwise protect our legitimate interests.

  • Development Records Each Party shall maintain complete, current and accurate records of all Development activities conducted by it hereunder, and all data and other information resulting from such activities. Such records shall fully and properly reflect all work done and results achieved in the performance of the Development activities in good scientific manner appropriate for regulatory and patent purposes. Each Party shall document all non-clinical studies and Clinical Trials in formal written study reports according to Applicable Laws and national and international guidelines (e.g., ICH, cGCP, cGLP, and cGMP).

  • Product ACCEPTANCE Unless otherwise provided by mutual agreement of the Authorized User and the Contractor, Authorized User(s) shall have thirty (30) days from the date of delivery to accept hardware products and sixty (60) days from the date of delivery to accept all other Product. Where the Contractor is responsible for installation, acceptance shall be from completion of installation. Failure to provide notice of acceptance or rejection or a deficiency statement to the Contractor by the end of the period provided for under this clause constitutes acceptance by the Authorized User(s) as of the expiration of that period. The License Term shall be extended by the time periods allowed for trial use, testing and acceptance unless the Commissioner or Authorized User agrees to accept the Product at completion of trial use. Unless otherwise provided by mutual agreement of the Authorized User and the Contractor, Authorized User shall have the option to run testing on the Product prior to acceptance, such tests and data sets to be specified by User. Where using its own data or tests, Authorized User must have the tests or representative set of data available upon delivery. This demonstration will take the form of a documented installation test, capable of observation by the Authorized User, and shall be made part of the Contractor’s standard documentation. The test data shall remain accessible to the Authorized User after completion of the test. In the event that the documented installation test cannot be completed successfully within the specified acceptance period, and the Contractor or Product is responsible for the delay, Authorized User shall have the option to cancel the order in whole or in part, or to extend the testing period for an additional thirty (30) day increment. Authorized User shall notify Contractor of acceptance upon successful completion of the documented installation test. Such cancellation shall not give rise to any cause of action against the Authorized User for damages, loss of profits, expenses, or other remuneration of any kind. If the Authorized User elects to provide a deficiency statement specifying how the Product fails to meet the specifications within the testing period, Contractor shall have thirty (30) days to correct the deficiency, and the Authorized User shall have an additional sixty (60) days to evaluate the Product as provided herein. If the Product does not meet the specifications at the end of the extended testing period, Authorized User, upon prior written notice to Contractor, may then reject the Product and return all defective Product to Contractor, and Contractor shall refund any monies paid by the Authorized User to Contractor therefor. Costs and liabilities associated with a failure of the Product to perform in accordance with the functionality tests or product specifications during the acceptance period shall be borne fully by Contractor to the extent that said costs or liabilities shall not have been caused by negligent or willful acts or omissions of the Authorized User’s agents or employees. Said costs shall be limited to the amounts set forth in the Limitation of Liability Clause for any liability for costs incurred at the direction or recommendation of Contractor.

  • Random Drug Testing All employees covered by this Agreement shall be subject to random drug testing in accordance with Appendix D.

  • Quality Specifications SANMINA-SCI shall comply with the quality specifications set forth in its Quality Manual, incorporated by reference herein, a copy of which is available from SANMINA-SCI upon request.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!