Common use of IRO Qualifications Clause in Contracts

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare and state Medicaid program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare Federal health care program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare and state Medicaid program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare and state Medicaid program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification experience in providing healthcare services under the Medicare Hospice Benefit, including making eligibility and who have maintained this certification (e.g., completed applicable continuing education requirements)level of care decisions; 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare and program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review who have expertise in the Medicare billing, coding, claims submission and other applicable Federal health care program requirements applicable to the claims being reviewedrequirements; 2. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims Review; and 5. have sufficient staff and resources to conduct the reviews required by the CIA IA on a timely basis.

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Claims Review Reviews who have expertise in the Medicare Federal health care program requirements applicable to the claims being reviewed; 2. assign individuals to design and select the Claims Review sample samples who are knowledgeable about the appropriate statistical sampling techniques; 3. assign individuals to conduct the coding review portions of the Claims Review Reviews who have a nationally recognized coding certification and who have maintained this certification (e.g., completed applicable continuing education requirements); 4. assign licensed nurses or physicians with relevant education, training and specialized expertise (or other licensed health care professionals acting within their scope of practice and specialized expertise) to make the medical necessity determinations required by the Claims ReviewReviews; and 5. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.