Common use of IRO Responsibilities The IRO shall Clause in Contracts

IRO Responsibilities The IRO shall. ‌‌ 1. perform each Quarterly Claims Review in accordance with the specific requirements of the IA;‌ 2. follow all applicable Medicare and state Medicaid program rules and reimbursement guidelines in making assessments in the Claims Review;‌ 3. request clarification from the appropriate authority (e.g., Medicare contractor), if in doubt of the application of a particular Medicare or state Medicaid program policy or regulation;‌‌ 4. respond to all OIG inquires in a prompt, objective, and factual manner; and 5. prepare timely, clear, well-written reports that include all the information required by Appendix B to the IA.

IRO Responsibilities The IRO shall. ‌‌ 1. perform each Quarterly Claims Review in accordance with the specific requirements of the IA;‌ 2. follow all applicable Medicare and state Medicaid program rules and reimbursement guidelines and State Board of Pharmacy requirements in making assessments in the Claims Review;‌ 3. request clarification from the appropriate authority (e.g., Medicare contractor), if in doubt of the application of a particular Medicare or state Medicaid program policy or regulation;‌‌ 4. respond to all OIG inquires in a prompt, objective, and factual manner; and 5. prepare timely, clear, well-written reports that include all the information required by Appendix B and Appendix C to the IA.