Common use of Final Medicare Reconciliation and Settlement Clause in Contracts

Final Medicare Reconciliation and Settlement. In the event the Contractor terminates or non-renews this Contract, CMS‘ final settlement phase for terminating contracts applies. This final settlement phase lasts a minimum of eighteen (18) months after the end of the calendar year in which the termination date occurs. This final settlement will include reconciliation of any Demonstration- specific payments or recoupments, including those related to joint Medicare A/B-Medicaid risk corridors, quality withhold, and medical loss ratios, as applicable, that are outstanding at the time of termination. Audits/Monitoring CMS and EOHHS will conduct periodic audits to validate RC assignments or other coding. Audits may be conducted by a peer review organization or other entity assigned this responsibility by CMS and EOHHS. Family Planning Services Reconciliation Process EOHHS shall perform an annual family planning services reconciliation as follows. EOHHS shall: Calculate all FFS claims paid by EOHHS for family planning services, including family planning pharmacy services, provided to Enrollees each CY; and Deduct the amount of such claims paid from a future capitation payment to the Contractor after written notification to the Contractor of the amount and timing of such deduction.

Final Medicare Reconciliation and Settlement. In the event the Contractor terminates or non-renews this Contract, CMS‘ ’ final settlement phase for terminating contracts applies. This final settlement phase lasts a minimum of eighteen (18) months after the end of the calendar year in which the termination date occurs. This final settlement will include reconciliation of any Demonstration- Demonstration-specific payments or recoupments, including those related to joint Medicare A/B-Medicaid risk corridors, quality withhold, and medical loss ratios, as applicable, that are outstanding at the time of termination. Audits/Monitoring CMS and EOHHS will conduct periodic audits to validate RC assignments or other coding. Audits may be conducted by a peer review organization or other entity assigned this responsibility by CMS and EOHHS. Family Planning Services Reconciliation Process EOHHS shall perform an annual family planning services reconciliation as follows. EOHHS shall: Calculate all FFS claims paid by EOHHS for family planning services, including family planning pharmacy services, provided to Enrollees each CY; and Deduct the amount of such claims paid from a future capitation payment to the Contractor after written notification to the Contractor of the amount and timing of such deduction.