Hospital Bill and Credit Balance Audits Sample Clauses

Hospital Bill and Credit Balance Audits. (1) The Company shall perform hospital bill audits and credit balance account audits. Such audits are limited to those inpatient, outpatient, emergency and trauma hospitalization claims that the Company has identified as meeting its auditing guidelines (hereafter, "Claim"). Each hospital bill audit entails a comparison of billed services to services ordered and/or documented in the medical record. Upon conclusion of each hospital bill audit, the Company will present the applicable facility and/or provider with a billing listing the overcharges and undercharges, if any and reflecting the net total overcharges due or net undercharges payable, and will employ commercially reasonable efforts to recover the overcharges from the facility and/or provider. In the event that the audit results in net undercharges payable to the facility and/or provider, the Client agrees to pay any such net undercharges. (2) As compensation for its services, the Client agrees to pay the Company the following fees, which fees or a part thereof may be paid to any third party vendor that assisted with the recovery: (a) Fees equal to 35.4% of all audit savings which are recovered following the commencement of any hospital bill audit or credit balance account audit undertaken by the Company. The Company has the right to offset any fees owed to it by the Client against any audit savings recovery amounts. (b) Fees equal to 35.4% of the identified audit savings should the Client request that the Company forego recovery of a specific overpayment or positive balance after the audit process is complete. (c) Company reserves the right to change the rate of the fees by giving the Client at least sixty (60) days advance written notice of the change. The fees stated in Section 11.B.2a and b above are inclusive of the Company’s administrative and transactional charges and any third party vendor fees.
Sample 1Sample 2
AutoNDA by SimpleDocs

Related to Hospital Bill and Credit Balance Audits

  • Medical Examinations An employee may be required by the Employer, at the request of and at the expense of the Employer, to take a medical examination by a physician of the employee's choice. Employees may be required to take skin tests, x-ray examination, vaccination, inoculation and other immunization (with the exception of a rubella vaccination when the employee is of the opinion that a pregnancy is possible), unless the employee's physician has advised in writing that such a procedure may have an adverse affect on the employee's health.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • Dental Care Plan The Welfare Plan will include a Dental Care Plan which will reimburse members for expenses incurred in respect of the coverages summarized in Appendix "1". The Plan will not duplicate benefits provided now or which may be provided in the future by any government program.

  • Medical Verification The Town may require medical verification of an employee’s absence if the Town perceives the employee is abusing sick leave or has used an excessive amount of sick leave. The Town may require medical verification of an employee’s absence to verify that the employee is able to return to work with or without restrictions.

  • Health Care Spending Account After six (6) months of permanent employment, full time and part time (20/40 or greater) employees may elect to participate in a Health Care Spending Account (HCSA) Program designed to qualify for tax savings under Section 125 of the Internal Revenue Code, but such savings are not guaranteed. The HCSA Program allows employees to set aside a predetermined amount of money from their pay, not to exceed the maximum amount authorized by federal law, per calendar year, of before tax dollars, for health care expenses not reimbursed by any other health benefit plans. HCSA dollars may be expended on any eligible medical expenses allowed by Internal Revenue Code Section 125. Any unused balance is forfeited and cannot be recovered by the employee.

  • Inventory Management The Subrecipient must submit an annual statement identifying the status of all equipment and non-real property items purchased with ESG funds by the contract termination date. The status report should inventory all equipment and non-real properties purchased with ESG funds and state the condition of the equipment and its location.

  • Health Examinations The Employer shall provide at no cost to the employee, such medical tests, health examinations and surveillance/monitoring as may be required as a condition of employment and/or as a result of regulated hazards encountered after employment.

  • Tax Examinations Abroad 1. A Contracting Party may allow representatives of the competent authority of the other Contracting Party to enter the territory of the first-mentioned Party to interview individuals and examine records with the written consent of the persons concerned. The competent authority of the second-mentioned Party shall notify the competent authority of the first-mentioned Party of the time and place of the meeting with the individuals concerned. 2. At the request of the competent authority of one Contracting Party, the competent authority of the other Contracting Party may allow representatives of the competent authority of the first-mentioned Party to be present at the appropriate part of a tax examination in the second-mentioned Party. 3. If the request referred to in paragraph 2 is acceded to, the competent authority of the Contracting Party conducting the examination shall, as soon as possible, notify the competent authority of the other Party about the time and place of the examination, the authority or official designated to carry out the examination and the procedures and conditions required by the first-mentioned Party for the conduct of the examination. All decisions with respect to the conduct of the tax examination shall be made by the Party conducting the examination.

  • Eye Examinations All represented employees, who are health service system members, shall be eligible for one (1) annual VDT examination and prescribed eyewear.

  • Dental Care a. Dental Care for Members over age 19 is limited to the following: i. care and stabilization treatment rendered within 62 days of an Accidental Dental Injury provided such services are for the treatment of damage to Sound Natural Teeth; ii. extraction of teeth required prior to radiation therapy when you have a diagnosis of cancer of the head or neck. b. General anesthesia and hospitalization services are covered when required to assure the safe delivery of necessary dental treatment or surgery for a dental Condition which, if left untreated, is likely to result in a medical Condition if: i. a Member has one or more medical Conditions that would create significant or undue medical risk for the Member in the course of delivery of any necessary dental treatment or surgery if not rendered in a Hospital or Ambulatory Surgery Center; or ii. a Covered Dependent child is under eight years of age and it is determined by a licensed dentist and the Covered Dependent’s Attending Physician that dental treatment or surgery in a Hospital or Ambulatory Surgery Center is necessary due to a significantly complex dental Condition, or a developmental disability in which patient management in the dental office has proven to be ineffective.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!