Common use of Maintenance of Records and Audits Clause in Contracts

Maintenance of Records and Audits. a. Participating Physicians and Practice shall, and Practice shall contractually require its Providers to, maintain in an accurate and timely manner, operational, financial, administrative and medical records, contracts, books, files and other documents (including data related to Medicare utilization and costs, quality performance measures, shared savings distributions, and other financial arrangements related to Model 4 activities) (“Records”) in connection with Covered Services performed under this Agreement. Such Records shall, at a minimum, be prepared, maintained and retained in accordance with generally accepted medical practices and applicable state and federal laws and regulations, EIP’s policies, and the Model 4 Agreement, and shall be sufficient to allow EIP to determine whether Practice, Participating Physicians and Providers are performing their obligations under this Agreement consistent with the terms hereof and in accordance with Applicable Requirements. b. Upon request, Practice or a Participating Physician shall give HHS, the Comptroller General of the United States, CMS, EIP and/or their designees the right to access, audit, investigate, evaluate, and inspect any Records of Practice or any Participating Physician or Provider that pertain to: (1) Awardee’s compliance with the Model 4 Agreement or Practice’s, any Participating Physician’s or any Provider’s compliance with the Model 4 Requirements; (2) the quality of services performed and determination of amounts due to or from CMS under the Model 4 Agreement; (3) patient safety, (4) Medicare Part A and Part B billing during an Episode of Care, and (5) any other lawful purpose related to Model 4. c. Practice shall furnish copies of Records at no additional cost to EIP, and EIP will provide such Records directly to the applicable regulatory agency unless EIP, in its discretion, directs Practice to furnish copies directly to the applicable regulatory agency. d. Practice shall permit CMS, HHS, the Comptroller General and EIP or their respective designees to conduct on-site evaluations of Practice, Participating Physicians, Providers, and physical premises, facilities and equipment to assess and audit Practice’s, Participating Physicians’ and Providers’ performance under this Agreement and compliance with Applicable Requirements. e. The terms of this Section 8, including the provisions with respect to maintenance of Records by Practice, Participating Physicians and Providers, shall remain in effect for a period of the longer of (a) ten (10) years from the final date of the Model 4 Agreement period; or (b) completion of any audit, evaluation, or inspection; unless (i) CMS determines there is a special need to retain a particular Record or group of Records for a longer period and notifies EIP or Practice at least thirty (30) days before the normal disposition date; or (ii) there has been a termination, dispute, or allegation of fraud or similar fault against EIP, Practice, a Participating Physician, a Provider, EIP’s providers or other individuals or entities performing functions or services related to EIP’s activities under the Model 4 Agreement, in which case Practice shall retain Records for an additional six (6) years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.

Maintenance of Records and Audits. a. Participating Physicians and Practice shall, and Practice shall contractually require its Providers to, maintain in an accurate and timely manner, operational, financial, administrative and medical records, contracts, books, files and other documents (including data related to Medicare utilization and costs, quality performance measures, shared savings distributions, and other financial arrangements related to Model 4 ACO activities) (“Records”) in connection with Covered Services performed under this Agreement. Such Records shall, at a minimum, be prepared, maintained and retained in accordance with generally accepted medical practices and applicable state and federal laws and regulations, EIPACO’s policies, and the Model 4 MSSP Agreement, and shall be sufficient to allow EIP ACO to determine whether Practice, Participating Physicians and Providers are performing their obligations under this Agreement consistent with the terms hereof and in accordance with Applicable Requirements. b. Upon request, Practice or a Participating Physician shall give HHS, the Comptroller General of the United States, CMS, EIP ACO and/or their designees the right to access, audit, investigate, evaluate, and inspect any Records of Practice or any Participating Physician or Provider that pertain to: (1) Awardee’s compliance with the Model 4 Agreement or Practice’s, any Participating Physician’s or any Provider’s compliance with the Model 4 MSSP Requirements; (2) the quality of services performed and determination of amounts amount due to or from CMS under the Model 4 MSSP Agreement; (3) patient safety, data related to Medicare utilization and costs; and (4) Medicare Part A the ability of the ACO to bear the risk of potential losses and Part B billing during an Episode of Care, and (5) to repay any other lawful purpose related losses to Model 4CMS. c. Practice shall furnish copies of Records at no additional cost to EIPACO, and EIP ACO will provide such Records directly to the applicable regulatory agency unless EIPACO, in its discretion, directs Practice to furnish copies directly to the applicable regulatory agency. d. Practice shall permit CMS, HHS, the Comptroller General and EIP ACO or their respective designees to conduct on-site evaluations of Practice, Participating Physicians, Providers, and physical premises, facilities and equipment to assess and audit Practice’s, Participating Physicians’ and Providers’ performance under this Agreement and compliance with Applicable Requirements. e. The terms of this Section 810, including the provisions with respect to maintenance of Records by Practice, Participating Physicians and Providers, shall remain in effect for a period of the longer of (a) ten (10) years from the final date of the Model 4 MSSP Agreement period; or (b) completion of any audit, evaluation, or inspection; unless (i) CMS determines there is a special need to retain a particular Record or group of Records for a longer period and notifies EIP ACO or Practice at least thirty (30) days before the normal disposition date; or (ii) there has been a termination, dispute, or allegation of fraud or similar fault against EIP, Practice, a Participating Physician, a Provider, EIP’s providers or other individuals or entities performing functions or services related to EIP’s activities under the Model 4 Agreement, in which case Practice shall retain Records for an additional six (6) years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.thirty

Maintenance of Records and Audits. a. Participating Physicians Provider shall maintain and Practice shall, and Practice shall contractually require its Practice Providers to, and Suppliers to maintain in an accurate and timely manner, operational, financial, administrative and medical records, contracts, books, files and other documents (including data related as required legally or pursuant to Medicare utilization and costs, quality performance measures, shared savings distributions, and other financial arrangements related to Model 4 activities) prudent business practices in connection with services performed under this Agreement (“Records”) in connection with Covered Services performed under this Agreement). Such Records shall be maintained in a timely and accurate manner and shall, at a minimum, be prepared, maintained and retained in accordance with generally accepted medical practices and applicable state and federal laws and regulations, EIP’s policies, and the Model 4 Agreement, and shall be sufficient to allow EIP ACO to determine whether PracticeProvider, Participating Physicians Practice Providers, and Providers its Suppliers are performing their obligations under this Agreement consistent with the terms hereof of this Agreement and in accordance with Applicable RequirementsRequirements and to confirm that the data submitted by Provider, Practice Providers, and its Suppliers for reporting and other purposes is accurate. b. Upon request, Practice or a Participating Physician Provider shall give HHSand shall contractually require its Practice Providers and Suppliers to give ACO, the U.S. Department of Health and Human Services, the Comptroller General of the United States, CMS, EIP and/or their designees the right to access, audit, investigate, evaluate, and inspect any Records books, contracts, computer or electronic systems and records, including medical records, patient care documentation, encounter data, and other records of the Provider, Practice Provider, or any Participating Physician Supplier or Provider its transferee that pertain to: (1) Awardee’s to any aspect of this Agreement, including, without limitation, services performed under this Agreement, ACO’s, Provider’s, and Practice Providers’ compliance with the Model 4 Agreement or Practice’sMSSP, any Participating Physician’s or any Provider’s compliance with the Model 4 Requirements; (2) the quality of services performed performed, data related to Medicare utilization and determination of amounts due costs; quality performance measures, MSSP distributions other financial arrangements to related to this Agreement, or from CMS under such other Records as may deemed necessary to enforce the Model 4 MSSP Agreement; (3) patient safety. Provider, (4) Medicare Part A and Part B billing during an Episode of CarePractice Providers, and (5) any other lawful purpose related to Model 4. c. Practice Suppliers shall furnish such access, audit, evaluation and inspection rights by providing copies of such Records to ACO at no additional cost to EIP, and EIP ACO will provide such Records directly to the applicable regulatory agency agency, unless EIPACO, in its discretion, directs Practice Provider, Pactice Provider, or Supplier to furnish copies directly to the applicable regulatory agency. d. c. Provider agrees to permit and shall contractually require Practice shall Providers and Suppliers to permit ACO, CMS, HHS, the Comptroller General and EIP ACO or their respective designees to conduct on-site evaluations of PracticeProvider, Participating Physicians, ProvidersPractice Provider, and Supplier personnel, physical premises, facilities and equipment to assess and audit PracticeProvider’s, Participating Physicians’ Practice Provider’s, and Providers’ Supplier’s performance under this Agreement and compliance with Applicable Requirements. e. d. The terms of this Section 810, including the provisions with respect to maintenance of Records by PracticeProvider, Participating Physicians Practice Providers, and ProvidersSuppliers, shall remain in effect effort for a period of the longer of (a) ten (10) years from the final date of the Model 4 MSSP Agreement period; or (b) completion of any audit, evaluation, or inspection; unless (i) CMS determines there is a special need to retain a particular Record or group of Records for a longer period and notifies EIP or Practice ACO at least thirty (30) days before the normal disposition date; or (ii) there has been a termination, dispute, or allegation of fraud or similar fault against EIPACO, PracticeProvider or its , a Participating PhysicianPractice Providers, a ProviderACO’s other providers and/or suppliers, EIP’s providers or other individuals or entities performing functions or services related to EIPACO’s activities under the Model 4 MSSP Agreement, in which case Provider shall and shall contractually require its Practice shall Providers and Suppliers to retain Records for an additional six (6) years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.

Maintenance of Records and Audits. a. Participating Physicians and Practice shall, and Practice shall contractually require its Providers to, maintain in an accurate and timely manner, operational, financial, administrative and medical records, contracts, books, files and other documents (including data related to Medicare utilization and costs, quality performance measures, shared savings distributions, and other financial arrangements related to Model 4 ACO activities) (“Records”) in connection with Covered Services performed under this Agreement. Such Records shall, at a minimum, be prepared, maintained and retained in accordance with generally accepted medical practices and applicable state and federal laws and regulations, EIPACO’s policies, and the Model 4 MSSP Agreement, and shall be sufficient to allow EIP ACO to determine whether Practice, Participating Physicians and Providers are performing their obligations under this Agreement consistent with the terms hereof and in accordance with Applicable Requirements. b. Upon request, Practice or a Participating Physician shall give HHS, the Comptroller General of the United States, CMS, EIP ACO and/or their designees the right to access, audit, investigate, evaluate, and inspect any Records of Practice or any Participating Physician or Provider that pertain to: (1) Awardee’s compliance with the Model 4 Agreement or Practice’s, any Participating Physician’s or any Provider’s compliance with the Model 4 MSSP Requirements; (2) the quality of services performed and determination of amounts amount due to or from CMS under the Model 4 MSSP Agreement; (3) patient safety, data related to Medicare utilization and costs; and (4) Medicare Part A the ability of the ACO to bear the risk of potential losses and Part B billing during an Episode of Care, and (5) to repay any other lawful purpose related losses to Model 4CMS. c. Practice shall furnish copies of Records at no additional cost to EIPACO, and EIP ACO will provide such Records directly to the applicable regulatory agency unless EIPACO, in its discretion, directs Practice to furnish copies directly to the applicable regulatory agency. d. Practice shall permit CMS, HHS, the Comptroller General and EIP ACO or their respective designees to conduct on-site evaluations of Practice, Participating Physicians, Providers, and physical premises, facilities and equipment to assess and audit Practice’s, Participating Physicians’ and Providers’ performance under this Agreement and compliance with Applicable Requirements. e. The terms of this Section 810, including the provisions with respect to maintenance of Records by Practice, Participating Physicians and Providers, shall remain in effect for a period of the longer of (a) ten (10) years from the final date of the Model 4 MSSP Agreement period; or (b) completion of any audit, evaluation, or inspection; unless (i) CMS determines there is a special need to retain a particular Record or group of Records for a longer period and notifies EIP ACO or Practice at least thirty (30) days before the normal disposition date; or (ii) there has been a termination, dispute, or allegation of fraud or similar fault against EIPACO, Practice, a Participating Physician, a Provider, EIPACO’s Network providers or other individuals or entities performing functions or services related to EIPACO’s activities under the Model 4 MSSP Agreement, in which case Practice shall retain Records for an additional six (6) years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.

Maintenance of Records and Audits. a. Participating Physicians and Practice shall, and Practice The Participant shall be contractually require its Providers required to, maintain in an accurate and timely manner, manner operational, financial, administrative and medical records, contracts, books, files and other documents (including data related to Medicare utilization and costs, quality performance measures, shared savings distributions, and other financial arrangements related to Model 4 ACO activities) (“Records”) in connection with Covered Services performed under this Agreement. Such Records shall, at a minimum, be prepared, maintained and retained in accordance with generally accepted medical practices and applicable state and federal laws and regulations, EIPACO’s policies, and the Model 4 MSSP Agreement, and shall be sufficient to allow EIP the ACO to determine whether Practice, the Participating Physicians and Providers are performing their obligations under this Agreement consistent with the terms hereof and in accordance with Applicable Requirements. b. Upon request, Practice or a Participating Physician the Participant shall give HHS, the Comptroller General of the United States, CMS, EIP the ACO and/or their designees the right to access, audit, investigate, evaluate, and inspect any Records of Practice or any Participating Physician or Provider the Participant that pertain to: (1) Awardeethe Participant’s compliance with the Model 4 Agreement or Practice’s, any Participating Physician’s or any Provider’s compliance with the Model 4 MSSP Requirements; (2) the quality of services performed and determination of amounts amount due to or from CMS under the Model 4 MSSP Agreement; (3) patient safety, data related to Medicare utilization and costs; and (4) Medicare Part A the ability of the ACO to bear the risk of potential losses and Part B billing during an Episode of Care, and (5) to repay any other lawful purpose related losses to Model 4CMS. c. Practice The Participant shall furnish copies of Records at no additional cost to EIPthe ACO, and EIP the ACO will provide such Records directly to the applicable regulatory agency unless EIPthe ACO, in its discretion, directs Practice the Participant to furnish copies directly to the applicable regulatory agency. d. Practice The Participant shall permit CMS, HHS, the Comptroller General and EIP the ACO or their respective designees to conduct on-site evaluations of Practice, the Participating Physicians, Providers, and physical premises, facilities and equipment to assess and audit Practice’s, the Participating Physicians’ and Providers’ Provider’s performance under this Agreement and compliance with Applicable Requirements. e. The terms of this Section 811, including the provisions with respect to maintenance of Records by Practice, the Participating Physicians and Providers, shall remain in effect for a period of the longer of (a) ten (10) years from the final date of the Model 4 MSSP Agreement period; or (b) completion of any audit, evaluation, or inspection; unless (i) CMS determines there is a special need to retain a particular Record or group of Records for a longer period and notifies EIP the ACO or Practice Participant at least thirty (30) days before the normal disposition date; or (ii) there has been a termination, dispute, or allegation of fraud or similar fault against EIPthe ACO, Practicethe Participant, a Participating Physician, a Provider, EIPthe ACO’s Network providers or other individuals or entities performing functions or services related to EIPthe ACO’s activities under the Model 4 MSSP Agreement, in which case Practice the Participant shall retain Records for an additional six (6) years from the date of any resulting final resolution of the termination, dispute, or allegation of fraud or similar fault.