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Common use of IRO Qualifications Clause in Contracts

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Eligibility and Appropriate Level of Services Reviews who have expertise in hospice eligibility and medical necessity, and the billing, coding, reporting, and other requirements of the Medicare hospice benefit and in the general requirements of the Federal health care programs from which Good Xxxxxxxx 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 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.

Appears in 4 contracts

Samples: Corporate Integrity Agreement, Corporate Integrity Agreement, Corporate Integrity Agreement

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Eligibility and Appropriate Level of Services Reviews who have expertise in hospice eligibility and medical necessity, and the billing, coding, reporting, and other requirements of the Medicare hospice benefit and in the general requirements of the Federal health care programs from which Good Xxxxxxxx Shepherd 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 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.

Appears in 1 contract

Samples: Corporate Integrity Agreement

IRO Qualifications. The IRO shall: 1. assign individuals to conduct the Eligibility Arrangements Review who are knowledgeable in the requirements of the Anti-Kickback Statute and Appropriate Level of Services Reviews the regulations and other guidance documents related to these statutes; and 2. assign individuals to conduct the Claims Review who have expertise in hospice eligibility and medical necessity, and the billing, coding, reporting, claims submission and other requirements of the applicable Medicare hospice benefit and in the general requirements of the Federal health care programs from which Good Xxxxxxxx seeks reimbursementstate Medicaid program requirements; 23. 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 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.

Appears in 1 contract

Samples: Corporate Integrity Agreement