Common use of Full Sample Clause in Contracts

Full Sample. If necessary, as determined by procedures set forth in Section A.4a above, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC or under LHC’s control to determine whether the medical record documentation supports homebound status and the medical necessity of the home health services furnished. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC the CareAll Entities or under LHC’s the CareAll Entities’ control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC the CareAll Entities to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovea Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Xxxxxxxxxx Regional or under LHCHutchinson Regional’s control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Xxxxxxxxxx Regional to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Ho Medical’s office or under LHCHo Medical’s control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim submitted was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Ho Medical to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility each Subject Facility (Full Sample) using commonly accepted sampling methodsmethods and conduct a MDS Review on the Full Sample. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Ensign Group or under LHCEnsign Group’s control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Ensign Group to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Xx. Xxxxxxxx’x office or under LHC’s Xx. Xxxxxxxx’x control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim submitted was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Xx. Xxxxxxxx to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a aboveIII.E.2.a, the IRO shall select perform an additional sample of Beneficiary Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. methods and in accordance with Appendix D. The Full Sample shall be designed to: (1i) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2ii) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Gambro’s office or under LHCGambro’s control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO Gambro may use the Beneficiary Paid Claims sampled as part of the Gambro Healthcare, Inc. Corporate Integrity Agreement Discovery Sample, and the corresponding findings for those 10 Beneficiary Paid ClaimsClaims from each of the Clinics in the Sampling Frame, as part of its Full Sample, if: (1i) statistically appropriate and (2ii) the IRO Gambro selects the Full Sample Paid Claims Items using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Gambro to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Harmony-Xxxxxx or under LHC’s Harmony- Xxxxxx’x control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Harmony-Xxxxxx to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Harmony-Xxxxxx or under LHC’s Harmony- Xxxxxx’x control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Xxxxxxx-Xxxxxx to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Rotech or under LHCRotech’s control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims Items sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims50 Items, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims Items using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Rotech to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrierDurable Medical Equipment Medicare Administrative Contractors (DME MAC), carrier or fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a aboveIII.D.2.a, the IRO shall select perform an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. methods and in accordance with Appendix B. The Full Sample shall be designed to: (1i) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2ii) conform with the Centers for Medicare and Medicaid Services’ ' statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC PolyMedica's office or under LHC’s PolyMedica's control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO PolyMedica may use the Paid Claims Items sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims50 Items, as part of its Full Sample, if: (1i) statistically appropriate and (2ii) the IRO PolyMedica selects the Full Sample Paid Claims Items using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer POLYMEDICA CORPORATE INTEGRITY AGREEMENT the findings of the Full Sample (and any related workpapers) received from LHC PolyMedica to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.

Full Sample. If necessary, as determined by procedures set forth in Section A.4a abovethe Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that home health facility (Full Sample) using commonly accepted sampling methods. The Full Sample shall be designed to: (1) estimate the actual Overpayment in the population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate; and (2) conform with the Centers for Medicare and Medicaid Services’ statistical sampling for overpayment estimation guidelines. The Paid Claims selected for the Full Sample shall be reviewed based on supporting documentation available at LHC Xxxxxxx’x office or under LHC’s Xxxxxxx’x control and applicable billing and coding regulations and guidance to determine whether the medical record documentation supports homebound status claim submitted was correctly coded, submitted, and the medical necessity of the home health services furnishedreimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims sampled as part of the Discovery Sample, and the corresponding findings for those Paid Claims, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the Discovery Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from LHC Xxxxxxx to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or DMERC), for appropriate follow-up by that payor.