Common use of Full Sample Clause in Contracts

Full Sample. If the Discovery Sample indicates that either Error Rates is 5% or greater, the IRO shall select an additional sample of Medicare beneficiaries(Full Sample), using commonly accepted sampling methods. The medical records for the Medicare beneficiaries selected for the Full Sample shall be reviewed based on supporting documentation available at Good Shepherd or under Good Shepherd’s control and applicable billing and coding regulations and guidance to determine if the beneficiary was eligible upon admission and eligible for subsequent recertifications and, if eligible, whether the Level of Service billed to Medicare was appropriate. 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 Medicare beneficiaries sampled as part of the Discovery Sample, and the corresponding findings for those Medicare beneficiaries, as part of its Full Sample, if: (1) statistically appropriate and (2) the IRO selects the Full Sample Medicare beneficiaries 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. If the Discovery Sample is larger than the number of beneficiaries needed for a Full Sample, then the Discovery Sample shall be treated as the Full Sample. OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from Good Shepherd to the appropriate Federal health care program payor (e.g., Medicare contractor), for appropriate follow-up by that payor.