Common use of MDS Systems Review Clause in Contracts

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. If any of the Subject Facilities’ Ensign Group’s Discovery Sample identifies an Error Rate of 5% or greatergreater in any Subject Facility, ExtendicareEnsign Group’s IRO shall also conduct a MDS Systems Review for of that Subject Facility. The MDS Systems Review shall consist of the following: a. a review of ExtendicareEnsign Group’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.