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 billing, coding, reporting, and other requirements of ambulance transport services and in the general requirements of the Federal health care program(s) from which RMC seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 billing, coding, reporting, claims submission and other requirements of ambulance transport services applicable Medicare and in the general requirements of the Federal health care program(s) from which RMC seeks reimbursementTRICARE program requirements; 2. assign individuals who have expertise in determining the medical necessity of items and services pursuant to applicable Medicare and TRICARE requirements; 3. assign individuals to design and select the Claims Review sample who are knowledgeable about the appropriate statistical sampling techniques; 34. assign individuals to conduct the coding review portions of the Claims Review who have a nationally recognized coding certification and who have Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 45. 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 and Unallowable Cost Review who have expertise in the billing, coding, reporting, and other requirements of ambulance transport claims for chiropractor’s services and in the general requirements of the Federal health care program(s) from which RMC Ho Medical seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 (and Unallowable Cost Review, if applicable) who have expertise in the billing, coding, reporting, and other requirements of ambulance transport dental services claims and in the general requirements of the Federal health care program(s) from which RMC Ocean Dental seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 and Unallowable Cost Review engagements who have expertise in the billing, coding, reporting, and other requirements of ambulance transport services home health and other areas of care provided by Maxim, and in the general requirements of the Federal health care program(s) from which RMC Maxim seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 and Unallowable Cost Review, who have expertise in the billing, coding, reporting, and other requirements of ambulance transport services home health agencies and in the general requirements of the Federal health care program(s) from which RMC seeks the CareAll Entities seek reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 and Unallowable Cost Review, who have expertise in the billing, coding, reporting, and other requirements of ambulance transport services hospice and in the general requirements of the Federal health care program(s) from which RMC Xxxxxxx-Xxxxxx seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and 4. 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 billing, coding, reporting, and other requirements of ambulance transport services ensuring proper and accurate designation of patients into inpatient, outpatient, or observation status and in the general requirements of the Federal health care program(s) from which RMC Xxxxxxx seeks reimbursement; 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 Rural/Metro Corporation Corporate Integrity Agreement Appendix A maintained this certification (e.g., completed applicable continuing education requirements); and, 4. have sufficient staff and resources to conduct the reviews required by the CIA on a timely basis.