Eligibility Review. Any claimant deemed ineligible by the Claims Evaluator may appeal that decision to the Special Master or her designee by filing an eligibility appeal within 30 days on forms created by the office of the Special Master.
Eligibility Review. Borrowers re- ceiving interest assistance will be re- viewed annually within 30 to 60 days prior to the anniversary date of the loan. All existing agreements must be reviewed and processed for the upcom- ing 12 months during the review period. Interest assistance will not be renewed if the amount that the borrower quali- fies for is less than $20 per month.
(1) The Lender will obtain written verification of the income of each bor- rower and all adult members of the borrower’s household and conduct the review.
Eligibility Review. The IRO shall perform the Verification Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Verification Review.
Eligibility Review. The IRO shall select a Beneficiary Sample. For each Medicare beneficiary in the Beneficiary Sample, the IRO shall randomly select a Claim Period to be reviewed (Selected Claim Period). The IRO shall review the medical records of each Medicare beneficiary in the Beneficiary Sample based on the supporting documentation available at VITAS's offices or under VITAS's control and applicable billing and coding regulations and guidance to determine whether the beneficiary was eligible for hospice services for the Selected Claim Period. For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Selected Claim Period, the IRO shall review all claims for hospice services billed by VITAS for that beneficiary to determine whether the beneficiary was eligible for hospice services. The IRO shall submit a supplemental report no later than 90 days after the IRO completes its report. VITAS shall refund any Overpayments identified as a result of this additional review and documentation of the refund of any identified Overpayments shall be made available to OIG upon request. Additionally, the IRO shall perform a review of the system(s) and process(es) that resulted in VITAS's erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.
Eligibility Review. Contractor must accomplish an eligibility review and determination for received and completed applications which must minimally include the following:
(i) Perform all Services necessary to determine program eligibility according to Program Requirements for all applications that are received and completed by Applicants and advanced out of Step 1 (Intake) into Step 2 (Eligibility Review) according to Agency protocol.
(ii) Application processing must follow prioritization requirements as identified in Program Requirements.
(iii) Evaluate documentation submitted to determine property owner eligibility based on all Program Requirements as well as federal and State requirements. Contractor must review all components of the application to ensure the submitted documents comply with the guidelines and meet all eligibility criteria. The Case Manager will use both the Standard Operating Procedures and additional job aids to ensure all criteria are evaluated. This review must be completed within 30 calendar days and documented in Agency’s System of Record.
(iv) In accordance with Program Requirements, verify damage resulting from the qualifying disaster during eligibility review.
(v) Ensure Case Managers are informed of eligibility status. Transfer Applicant files who are ineligible to Case Managers to notify Applicants of their ineligible status and to conduct the appeals process as needed. Once the QA/ QC Lead reviews and approves or denies the application, the Case Manager must draft and send the notice of eligibility or ineligibility to the Applicant in writing and follow up using their preferred communication mode (phone, email, or text). Eligibility letters must be sent within 3 business days of the approval from the QA/ QC Lead, unless otherwise directed by Agency, and the application will then advance to Step 3 (DOB and VOB).
(vi) Complete each eligibility review within thirty (30) calendar days as described in Figure 1.
(vii) Contractor must monitor progress of applications within Step 2 (Eligibility Review) to ensure they are being reviewed according to program phase prioritization requirements and to ensure eligibility review is completed within the 30 calendar day timeframe. To ensure files are moving efficiently through the process and to identify potential bottlenecks, Contractor must generate a weekly aging report to be used by Contractor and Agency, as needed.
(viii) Contractor may invoice Agency for the eligibility unit per file when the eligibility r...
Eligibility Review. GRANTEE will review participant applications for eligibility status. This includes reviewing income, confirming homeless status, reviewing citizenship declaration, completing background and credit checks, calculating subsidy based on household occupancy, complete assistance contract with participant, issue housing coupon, and performing annual re-certifications as necessary.
Eligibility Review. Odyssey Hospice’s Eligibility Review Team, composed of individuals listed in Appendix B, shall review the eligibility of Odyssey Hospice’s Medicare beneficiaries for the hospice services those Medicare beneficiaries received and shall prepare an Eligibility Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference. Odyssey Corporate Integrity Agreement
Eligibility Review. The Eligibility Review Team shall perform the Eligibility Review annually to cover each of the five Reporting Periods. Subject to the IRO Verification Review and Section III.D.4 of the CIA, as applicable, the Eligibility Review Team shall perform all components of each Eligibility Review.
Eligibility Review. The IRO shall conduct the “Eligibility Review” to determine whether Medicare beneficiaries meet hospice eligibility criteria and shall include a review of (1) initial admissions (Admission Review) and (2) the most recent recertification period for Long Length of Stay patients (Long Length of Stay Review). The applicable definitions, procedures, and reporting requirements are outlined in Appendix B to this CIA, which is incorporated by reference.
Eligibility Review. The IRO shall select a Beneficiary Sample. The IRO shall review the medical records of the Medicare and Medicaid beneficiaries in the Beneficiary Sample to determine whether the beneficiaries were eligible for hospice services for each Claim Period for which a claim was submitted since the date of admission. The IRO shall review medical records for the Medicare beneficiaries selected based on the supporting documentation available at HOK’s offices or under HOK’s control and applicable billing and coding regulations and guidance to determine whether the Medicare or Medicaid beneficiary was eligible for the hospice benefit during each Claim Period. For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Claim Period, the IRO shall perform a review of the system(s) and process(es) that resulted in XXX’s erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.
