Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Quarterly Claims Sample. Within 15 days following the end of each three-month period during the term of this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all Xxxxx’x Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. The randomly selected 30 Paid Claims will be reviewed by the IRO based on the supporting documentation available at Xxxxx’x office or under Xxxxx’x control and applicable billing and coding regulations and guidance to determine whether each claim was correctly coded, submitted, and reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf ofNorthwest ENT during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG' s Office of Audit Services' Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xx x.xxx.xxx/xxxxxxxxxx/xxx-xxxxx/xxxxx.xxx. Northwest ENT IA Appenaix 8
Quarterly Claims Sample. Within 15 days following the end of each three-month period during the term of this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all Xxxxx’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. The IRO shall review the randomly selected 30 Paid Claims for (1) correct coding, submission, and reimbursement, and (2) medical necessity, appropriateness of case selection, quality of procedure, execution, proper response to intraprocedural problems, accurate assessment of procedure outcome, and appropriateness of procedure management. The Paid Claims shall be reviewed based on the supporting documentation available from Anand or under Xxxxx’s control and applicable regulations and guidance, including but not limited to applicable billing and coding regulations and guidance and the established practice guidelines and generally accepted standards practice described by the American College of Cardiology, to determine (1) whether each claim was correctly coded, submitted, and reimbursed, and (2) whether each procedure was medically necessary and appropriate. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims and Cardiac Procedures Review Report). The Quarterly Claims and Cardiac Procedures Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims and Cardiac Procedures Review.
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Alaska Neurology during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- 1 The overpayment definition and paid claim definition should be expanded to include other Federal health care programs if claims to those payors were at issue in the underlying case or represent a significant portion of the Practitioner’s payor mix. STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxx Pharmacy during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG's Office of Audit Services' Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxxx Xxxxx Professional Pharmacy, Inc. dlbla Xxxxx Pharmacy, Gwy Xxxx, and Xxxxxx X. Xxxxxxx Integrity Agreement- Appendix B
