MDS Systems Review. If any of the Subject Facilities’ Discovery Sample identifies an Error Rate of 5% or greater, Extendicare’s IRO shall also conduct a MDS Systems Review for that Subject Facility. The MDS Systems Review shall consist of the following:
a. a review of Extendicare’s billing and coding systems and processes relating to claims submitted to Medicare Part A (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing);
b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.
MDS Systems Review. The IRO shall prepare a report based on the MDS Systems Review (MDS Systems Review Report) that shall include the IRO’s observations, findings, and recommendations regarding:
a. the strengths and weaknesses in Xxxxxxx Lutheran’s medical record documentation, coding process, billing system, policies and procedures, internal controls, or reporting mechanisms;
b. the strengths and weaknesses in Xxxxxxx Lutheran’s medical record documentation, coding process, billing system, policies and procedures, internal controls or reporting mechanisms; and
c. possible improvements to Xxxxxxx Lutheran’s medical record documentation, coding process, billing system, policies and procedures, internal controls or reporting mechanisms to address the specific problems or weaknesses that resulted in the identified Overpayments.
MDS Systems Review. If Xxxxxxx Lutheran’s Discovery Sample identifies an Error Rate of 5% or greater, Xxxxxxx Lutheran’s IRO shall also conduct a MDS Systems Review. The MDS Systems Review shall consist of the following:
a. a review of Xxxxxxx Lutheran’s billing and coding systems and processes relating to claims submitted to Medicare Part A (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing);
b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.
