Common use of Full Sample Clause in Contracts

Full Sample. If any Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Sample. The Paid Claims shall be reviewed based on the supporting documentation available at Extendicare’s office or under Extendicare’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any the Discovery Sample at any CHSI Covered Facility selected for review indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that CHSI Covered Facility (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for any Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office CHSI or under ExtendicareCHSI’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the any 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare CHSI to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any the Discovery Sample at any Covered Facility selected for review indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that Covered Facility (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office Dignity Health or under ExtendicareDignity Health’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare Dignity Health to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any the Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) for that Subject Facility from the respective universe using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at ExtendicareCCH’s office offices or under ExtendicareCCH’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare CCH to the appropriate Federal health care program payor (e.g., Medicare contractor), ) for appropriate follow-up by that payor.

Full Sample. If any Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) for that Subject Facility from the Baptist hospital whose Paid Claims were reviewed using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office Baptist or under ExtendicareBaptist’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the a 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 appropriate; and, (2) the IRO selects the Full Sample Paid Claims using the seed number generated by the applicable Discovery Sample. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare Baptist to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any the Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from the Subject Facilities (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office to Amedisys or under ExtendicareAmedisys’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare Amedisys to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any a Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims Prescriptions (Full Sample) for that Subject Facility from the Prescription Population of the Selected Pharmacy using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims Prescriptions selected for any Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office or under Extendicare’s control and applicable billing and coding regulations and guidance the Selected Pharmacy to determine whether the claim was correctly codedSchedule II Controlled Substances were dispensed in accordance with the applicable provisions of the Controlled Substances Act, submittedstate statutes, and reimbursedfederal and state regulations and guidance. For purposes of calculating the size of the a Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. Additionally, the IRO may use the Paid Claims Prescriptions sampled as part of the Discovery Sample, and the corresponding findings for those Paid ClaimsPrescriptions, as part of its a Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Paid Claims Prescriptions using the seed number generated by the Discovery Sample. The findings of the a Full Sample shall be used by the IRO to estimate the actual Overpayment in the Prescription Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the a Full Sample (and any related workpapers) received from Extendicare PharMerica to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any the Discovery Sample for a selected Review Facility indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) for from the Population at that Subject Review Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office CHN or under ExtendicareCHN’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare CHN to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any either Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims relating to that Discovery Sample (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office Toccoa or under ExtendicareToccoa’s control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. For purposes of calculating the size of the Full Sample, the Discovery Sample may serve as the probe sample, if statistically appropriate. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare Toccoa to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.

Full Sample. If any either Discovery Sample indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims (Full Sample) for that Subject Facility using commonly accepted sampling methods and conduct a MDS Review on the Full Samplemethods. The Paid Claims selected for the Full Sample shall be reviewed based on the supporting documentation available at Extendicare’s office 21st Century or under Extendicare21st Century’s control and applicable billing and coding regulations and guidance to determine whether the items and services provided were medically necessary, and whether the claim was correctly coded, submitted, and reimbursed. 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. The findings of the Full Sample shall be used by the IRO to estimate the actual Overpayment in the Population with a 90% confidence level and with a maximum relative precision of 25% of the point estimate. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Extendicare 21st Century to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.