Common use of Quantitative Results Clause in Contracts

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Rotech. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim appraised: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech Pediatrix (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to RotechPediatrix. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim appraised: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech Xxxxxxx (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to RotechXxxxxxx. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim appraisedClaim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech MBPC (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to RotechMBPC. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim appraisedClaim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech the Providers (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Rotechthe Providers. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim appraisedClaim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech Xxxxxxx (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to RotechXxxxxxx. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim appraisedClaim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure 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. (See Attachment 1 to this Appendix.)