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 GLML 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. b. GLML shall provide the IRO with a list of all GLML’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. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s office or under GLML’s control and applicable Medicare, state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed. d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Practitioner 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.3h3TU ttps://xxx.xxx.xxx/xxxxxxxxxx/xxx-xxxxx/xxxxx.xxxX.00X
b. GLML Practitioner shall provide the IRO with a list of all GLMLPractitioner’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPractitioner’s office or under GLMLPractitioner’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Align 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. GLML Align shall provide the IRO with a list of all GLMLAlign’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLAlign’s office or under GLMLAlign’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Provider 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.
b. GLML Provider shall provide the IRO with a list of all GLMLProvider’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLProvider’s office or under GLMLProvider’s control and applicable Medicare, Medicare and state Medicaid program requirements and Medicaid Managed Care program applicable State Board of Pharmacy requirements to determine whether each prescription was dispensed according to a valid prescription, whether documentation of the items and services furnished were medically necessary prescription (including any refills) is maintained and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed. For each Paid Claim reviewed, the IRO should verify that Provider maintained documentation of: (1) the prescription order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML FHG 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML FHG shall provide the IRO with a list of all GLMLFHG’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLFHG’s office or under GLMLFHG’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML OGCC 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.
b. GLML OGCC shall provide the IRO with a list of all GLMLOGCC’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLOGCC’s office or under GLMLOGCC’s control and applicable Medicare, state Medicaid Medicaid, and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML LFAC 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.
b. GLML LFAC shall provide the IRO with a list of all GLMLLFAC’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLLFAC’s office or under GLMLLFAC’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 separate sample of 30 Paid Claims submitted by or on behalf of GLML Xxxxx, Integrated, Golden Management, and any Covered Entity during the preceding three-three- month period (Quarterly Claims Sample). The Each sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. GLML x. Xxxxx, Integrated, Golden Management and any Covered Entity each shall provide the IRO with a list of all GLML’s Paid Claims for the three-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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLthe applicable person/entity’s office or under GLMLthe applicable person/entity’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. The IRO shall prepare a written report of its findings from the each 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML EPIPG 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML EPIPG shall provide the IRO with a list of all GLMLEPIPG’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLEPIPG’s office or under GLMLEPIPG’s control and applicable Medicare, Tricare, and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Bhayani 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxxx shall provide the IRO with a list of all GLMLBhayani’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLBhayani’s office or under GLMLBhayani’s control and applicable Medicare, state Medicaid and program, or Medicaid Managed Care program managed care organization requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML Xxxxxxxxxx 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.
b. GLML . Xxxxxxxxxx shall provide the IRO with a list of all GLML’s Xxxxxxxxxx’x Paid Claims for the three-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.
c. . 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 by the IRO based on the supporting documentation available at GLML’s office from Chatterjee or under GLML’s Xxxxxxxxxx’x control and applicable Medicareregulations and guidance, state Medicaid including but not limited to applicable billing and Medicaid Managed Care program requirements 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 the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. , 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML MMW 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- RAT STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/ compliance/rat-stats/index.asp.
b. GLML MMW shall provide the IRO with a list of all GLMLMMW’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLMMW’s office or under GLMLMMW’s control and applicable Medicare, state Medicaid and Medicaid Managed Care Federal health care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML 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.
b. GLML . Xxxxx shall provide the IRO with a list of all GLMLXxxxx’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.
c. . 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 by the IRO based on the supporting documentation available at GLML’s office from Anand or under GLMLXxxxx’s control and applicable Medicareregulations and guidance, state Medicaid including but not limited to applicable billing and Medicaid Managed Care program requirements 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 the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. , 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.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML MBPC 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.
b. GLML . MBPC shall provide the IRO with a list of all GLMLMBPC’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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLMLMBPC’s office or under GLMLMBPC’s control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Corporate Integrity Agreement
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 GLML MPG 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. GLML MPG shall provide the IRO with a list of all GLMLMPG’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLMPG’s office or under GLMLMPG’s control and applicable Medicare, state Medicaid and Medicaid Managed Care program program, or TRICARE requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 60 Paid Claims submitted by or on behalf of GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML PC, Xxxxx, and Bandar shall provide the IRO with a list of all GLMLPC, Xxxxx, and Bandar’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 60 random numbers using RAT-STATS and then use the random numbers to identify the 30 60 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 30 60 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPC, Xxxxx, and Bandar’s office or under GLMLPC, Xxxxx, and Bandar’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Springfield 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Springfield shall provide the IRO with a list of all GLMLSpringfield’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLSpringfield’s office or under GLMLSpringfield’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Dr. Uradu and UTC 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- RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Dr. Uradu and UTC shall provide the IRO with a list of all GLMLDr. Uradu and UTC’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLDr. Uradu and UTC’s office or under GLMLDr. Uradu and UTC’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML DLDC 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML DLDC shall provide the IRO with a list of all GLMLDLDC’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLDLDC’s office or under GLMLDLDC’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements and applicable practice guidelines, including those promulgated by the American Society for Gastrointestinal Endoscopy and the American College of Gastroenterology, to determine whether the items and services furnished were medically necessary necessary, medically appropriate, and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.. For colonoscopy procedures in the Quarterly Claims Sample, the Quarterly Claims Review shall also determine whether DLDC recorded the following quality indicator data in the patient’s record: length of time since previous colonoscopy; indication for colonoscopy, diagnostic or screening; quality of bowel preparation; visualization of the cecum through notation of landmarks, including photo-documentation; adenoma detection; withdrawal time; any complications; and clinical recommendations.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Center for Pain Management 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Center for Pain Management shall provide the IRO with a list of all GLMLCenter for Pain Management’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-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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLCenter for Pain Management’s office or under GLMLCenter for Pain Management’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether (a) the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed; and (b) whether any diagnostic testing ordered was medically reasonable and necessary.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Qamar 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.
b. GLML x. Xxxxx shall provide the IRO with a list of all GLMLQamar’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLQamar’s office or under GLMLQamar’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
e. The findings of the Quarterly Claims Sample shall be used by the IRO to estimate the actual Overpayment in the Population at the mean point estimate.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML 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.
b. GLML . Xxxxx shall provide the IRO with a list of all GLML’s 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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLML’s Xxxxx’x office or under GLML’s Xxxxx’x control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML APS 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML APS shall provide the IRO with a list of all GLMLAPS’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLAPS’s office or under GLMLAPS’s control and applicable Medicare, Medicare Managed Care, Medicaid Managed Care, and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Gardi 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML x. Xxxxx shall provide the IRO with a list of all GLMLGardi’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLGardi’s office or under GLMLGardi’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML Xxxxx-JCA 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.
b. GLML . Xxxxx-JCA shall provide the IRO with a list of all GLMLXxxxx-JCA’s Paid Claims for the three-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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLMLXxxxx-JCA’s office or under GLMLXxxxx-JCA’s control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML LHMC 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.
b. GLML LHMC shall provide the IRO with a list of all GLMLLHMC’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLLHMC’s office or under GLMLLHMC’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML SPI 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML SPI shall provide the IRO with a list of all GLMLSPI’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLSPI’s office or under GLMLSPI’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether (1) the items and services furnished were medically necessary and appropriately documented, (2) all cost-sharing amounts (such as copayments and whether co-insurance) were collected or waived in accordance with applicable payor requirements, and (3) the claim Paid Claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxx shall provide the IRO with a list of all GLML’s Xxxxxx’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLNorman’s office or under GLML’s Xxxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary necessary, properly supervised, and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Xx. Xxx and Interventional Cardiology shall provide the IRO with a list of all GLMLXx. Xxx and Interventional Cardiology’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLXx. Xxx and Interventional Cardiology’s office or under GLMLXx. Xxx and Interventional Cardiology’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML 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.
b. GLML . Xxxxx shall provide the IRO with a list of all GLML’s Xxxxx’ 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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLML’s office Wiles’ offices or under GLML’s Xxxxx’ control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C B 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Foot Healers 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Foot Healers shall provide the IRO with a list of all GLML’s Foot Healers’ Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Foot Healers’ office or under GLML’s Foot Healers’ control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML LabTox 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML LabTox shall provide the IRO with a list of all GLMLLabTox’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLLabTox’s office or under GLMLLabTox’s control and applicable Medicare, state Medicaid and Medicaid, or Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML OC and 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.
b. GLML OC and Xxxxxx shall provide the IRO with a list of all GLML’s OC and Xxxxxx’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s OC and Xxxxxx’x office or under GLML’s OC and Xxxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed. The IRO also shall review the Quarterly Inventory Reconciliation Report prepared by OC and Xxxxxx for the quarter under review, to verify that the dosage amounts of any administered pharmaceuticals on the Paid Claims reviewed by the IRO are consistent with the available inventory of such administered pharmaceuticals.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Xxxxx Pharmacy during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s '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://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
b. GLML x. Xxxxx Pharmacy shall provide the IRO with a list of all GLML’s Xxxxx Pharmacy'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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Xxxxx Pharmacy's office or under GLML’s Xxxxx Pharmacy's control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Xxxx Clinic 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.
b. GLML x. Xxxx Clinic shall provide the IRO with a list of all GLMLXxxx Clinic’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLXxxx Clinic’s office or under GLMLXxxx Clinic’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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.
b. GLML x. Xxxxx shall provide the IRO with a list of all GLML’s 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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Xxxxx’x office or under GLML’s Xxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Xx. Xxxxx or any of the Cancer Centers 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Xx. Xxxxx shall provide the IRO with a list of all GLML’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Xx. Xxxxx’x office or any of the Cancer Centers or under GLML’s Xx. Xxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Practitioner 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.
b. GLML Practitioner shall provide the IRO with a list of all GLMLPractitioner’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPractitioner’s office or under GLMLPractitioner’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 business days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML Xxxxxxx 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp. Xxxxxxx shall provide the IRO with a list of all GLMLKrentel’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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLMLKrentel’s office or under GLMLKrentel’s control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxx shall provide the IRO with a list of all GLML’s Xxxxxx’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Xxxxxx’x office or under GLML’s Xxxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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 is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML x. Xxxxxx shall provide the IRO with a list of all GLML’s Xxxxxx’x Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims 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 Claims Population that will be subject to review by the IRO.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Xxxxxx’x office or under GLML’s Xxxxxx’x control and applicable Medicare, Medicare and state Medicaid program requirements and Medicaid Managed Care program applicable state Board of Pharmacy requirements to determine whether:
(1) the prescription drugs furnished by Xxxxxx were dispensed according to a valid prescription, (2) Xxxxxx maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug), and (3) whether the items and services furnished claims were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, billed and reimbursed.. For each Paid Claim reviewed, the IRO should verify that Xxxxxx maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.
d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C B 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Hanflink 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxxxx shall provide the IRO with a list of all GLMLHanflink’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population 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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLHanflink’s office or under GLMLHanflink’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxxxx Clinic shall provide the IRO with a list of all GLMLXxxxxxxx Clinic’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLXxxxxxxx Clinic’s office or under GLMLXxxxxxxx Clinic’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML the Providers during the preceding three-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.
b. GLML . The Providers shall provide the IRO with a list of all GLML’s the Providers’ 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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLML’s office the Providers’ offices or under GLML’s the Providers’ control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Practitioner shall provide the IRO with a list of all GLMLPractitioner’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPractitioner’s office or under GLMLPractitioner’s control and applicable Medicare, state Medicaid Medicaid, TRICARE and Medicaid Managed Care the Department of Veterans Affairs, Veterans Health Administration program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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- 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 at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Xxxxxx shall provide the IRO with a list of all GLMLHanora’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLHanora’s office or under GLMLHanora’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Dia-Foot 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Dia-Foot shall provide the IRO with a list of all GLMLDia-Foot’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-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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLDia-Foot’s office or under GLMLDia-Foot’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the manufacturing process for the items and services furnished were medically necessary and was appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.. In addition, the IRO’s review shall verify whether the items furnished were “custom-fabricated” (as defined in 42 U.S.C. § 1395m(h)) and were manufactured according to the specifications submitted by Dia-Foot to and approved by the PDAC Medicare contractor, including (1) for diabetic shoe inserts billed under HCPCS code A5513, that Dia-Foot maintained documentation to demonstrate that Dia-Foot obtained a clear impression of the specific patient’s foot, and used that impression to make a make a positive model of the patient’s foot from which the final product was crafted; and (2) for diabetic shoe inserts billed under HCPCS code A5514, that Dia-Foot maintained documentation to demonstrate that it obtained a scan of each foot (i.e., right and left) for which an insert was manufactured.
d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C B 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML CBHA 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML CBHA shall provide the IRO with a list of all GLMLCBHA’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLCBHA’s office or under GLMLCBHA’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Princeton Pathology 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Princeton Pathology shall provide the IRO with a list of all GLMLPrinceton Pathology’s Paid Claims for the three-month period covered by the 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPrinceton Pathology’s office or under GLMLPrinceton Pathology’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML Choudhary-Rolla 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML . Choudhary-Rolla Neurology shall provide the IRO with a list of all GLMLChoudhary-Rolla Neurology’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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLMLChoudhary-Rolla Neurology’s office or under GLMLChoudhary- Rolla Neurology’s control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML the Covered Entities at the Review Location 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML The Covered Entities shall provide the IRO with a list of all GLML’s the Covered Entities’ Paid Claims for the three-Review Location 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s the Covered Entities’ office or under GLML’s the Covered Entities’ control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML I&L 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML I&L shall provide the IRO with a list of all GLMLI&L’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims 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 Claims Population that will be subject to review by the IRO.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLI&L’s office or under GLMLI&L’s control and applicable Medicare, Medicare and state Medicaid program requirements and Medicaid Managed Care program applicable state Board of Pharmacy requirements to determine whether:
(1) the prescription drugs furnished by I&L were dispensed according to a valid prescription,
(2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug), and (3) whether the items and services furnished claims were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, billed and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.
d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C B 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML the Practice 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- RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML The Practice shall provide the IRO with a list of all GLML’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLthe Practice’s office or under GLMLthe Practice’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.https://oig.hhs.gov/compliance/rat-stats/index.asp.
b. GLML Dakwa and HEAG shall provide the IRO with a list of all GLMLDakwa’s and HEAG’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLDakwa’s and HEAG’s office or under GLMLDakwa’s or HEAG’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Xx. Xxxxxx-Xxxxxx D.P.M. 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- RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Xx. Xxxxxx-Xxxxxx D.P.M. shall provide the IRO with a list of all GLMLXx. Xxxxxx-Xxxxxx D.P.M.’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLXx. Xxxxxx-Xxxxxx D.P.M.’s office or under GLMLXx. Xxxxxx-Xxxxxx D.P.M.’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Gonzaga 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxxxx shall provide the IRO with a list of all GLMLGonzaga’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLGonzaga’s office or under GLMLGonzaga’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Skyline 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Skyline shall provide the IRO with a list of all GLMLSkyline’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLSkyline’s office or under GLMLSkyline’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.aspxxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. GLML x. Xxxxx shall provide the IRO with a list of all GLMLKelly’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLKelly’s office or under GLMLKelly’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.at
b. GLML x. Xxxxx, Ltd., 215, and Xxxxxxxx shall provide the IRO with a list of all GLML’s Monos, Ltd., 215, and Xxxxxxxx’x Paid Claims for the three-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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Monos, Ltd., 215, and Xxxxxxxx’x office or under GLML’s Monos, Ltd., 215, and Xxxxxxxx’x control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of GLML 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.
b. GLML . Xxxxx shall provide the IRO with a list of all GLML’s Xxxxx’ 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.
c. . The randomly selected 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at GLML’s office Xxxxx’ offices or under GLML’s Xxxxx’ control and applicable Medicare, state Medicaid billing and Medicaid Managed Care program requirements coding regulations and guidance to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the each claim was correctly coded, submitted, and reimbursed.
d. . The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C B 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML ofNorthwest ENT during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s ' 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.RAT- xxxxx://xx x.xxx.xxx/xxxxxxxxxx/xxx-xxxxx/xxxxx.xxx. Northwest ENT IA Appenaix 8
b. GLML Northwest ENT shall provide the IRO with a list of all GLML’s Northwest ENT'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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLML’s Northwest ENT's office or under GLML’s Northwest ENT's control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed., and, for procedures involving medical devices, whether the devices were used safely and appropriately.
d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Khanna 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.
b. GLML x. Xxxxxx shall provide the IRO with a list of all GLMLKhanna’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.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLKhanna’s office or under GLMLKhanna’s control and applicable Medicare, state Medicaid Medicare and Medicaid Managed Care TRICARE program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
d. 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.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML Kumar 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 at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML x. Xxxxx shall provide the IRO with a list of all GLMLKumar’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLKumar’s office or under GLMLKumar’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML during from 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- RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML Practitioner shall provide the IRO with a list of all GLMLPractitioner’s Paid Claims for the three-month period covered by the Quarterly 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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLPractitioner’s office or under GLMLPractitioner’s control and applicable Medicare, Medicare and state Medicaid and Medicaid Managed Care program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
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 GLML LCPCC 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://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. GLML LCPCC shall provide the IRO with a list of all GLMLLCPCC’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.IRO.
c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at GLMLLCPCC’s office or under GLMLLCPCC’s control and applicable Medicare, Medicare and state Medicaid program requirements and Medicaid Managed Care program applicable State Board of Pharmacy requirements to determine whether each prescription was dispensed according to a valid prescription, whether documentation of the items and services furnished were medically necessary prescription (including any refills) is maintained and appropriately documented, and whether the claim was correctly coded, submitted, submitted and reimbursed.. For each Paid Claim reviewed, the IRO should verify that LCPCC maintained documentation of: (1) the prescription order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.
d. 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.Review.
Appears in 1 contract
Samples: Integrity Agreement
