Common use of Quantitative Results Clause in Contracts

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted drawdowns by the U.S. Healthcare Supply DMEPOS Companies BPMC from PMS differed from what should have been the correct coding drawn down from PMS and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. ii. Total number and percentage of instances in which the IRO determined that a Paid Specified Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. iii. Total number and percentage of instances in which the IRO determined that a Paid Specified Claim was for items or services that were not medically necessary based upon unallowable costs and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Drawdown Review Sample. v. Total dollar amount of Paid Specified Claims included in the Drawdown Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Drawdown Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Drawdown Review Sample by the total dollar amount associated with the Paid Specified Claims in the Claims Drawdown Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixvii. A spreadsheet of the Claims Drawdown Review results that includes the following information for each Paid Specified Claim: Federal health care program award billed, beneficiary health insurance claim number, date of servicedrawdown, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO)drawn down through PMS, correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount, and reason for any difference between the amount drawn down through PMS and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Xxxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesXxxxxx. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesXxxxxx. iii. Total number and percentage dollar amount of instances all Overpayments in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesClaims Review Sample. iv. Total number and percentage dollar amount of instances all Overpayments in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companieseach Population. v. Total dollar amount of all Overpayments Paid Claims included in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sampleeach Population. vii. Error Rate The error rate in the Claims Review Sample. The Error Rate error rate in the Claims Review Sample shall be calculated by dividing the Overpayment total dollar amount of all Overpayments in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. The error rate in each Population. The error rate in each Population shall be calculated by dividing total dollar amount of Paid Claims in each Population by the total dollar amount associated with the Paid Claims in each Population. ix. An estimate of the actual Overpayment in the each Population at the mean point estimate. ix. x. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, location of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Xxxxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesXxxxxxx. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesXxxxxxx. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesXxxxxxx. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. v. Total dollar amount of Paid Claims included in the Claims Review Sample. viivi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. Total number and percentage of instances in which the IRO determined that copayments and other cost-sharing amounts were not collected or waived in accordance with applicable payor requirements and the total amount of such copayments or cost-sharing amounts. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, copayment or other cost sharing amount collected, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.