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 60 Paid Claims 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. b. PC, Xxxxx, and Bandar shall provide the IRO with a list of all PC, 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 60 random numbers using RAT-STATS and then use the random numbers to identify the 60 Paid Claims in the Population that will be subject to review by the IRO. c. The randomly selected 60 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s office or under PC, Xxxxx, and Bandar’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims 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-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. PC, Xxxxx, and Bandar Practitioner shall provide the IRO with a list of all PC, Xxxxx, and BandarPractitioner’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarPractitioner’s office or under PC, Xxxxx, and BandarPractitioner’s control and applicable Medicare Medicare, state Medicaid, TRICARE and state Medicaid 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.
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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. The Providers shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s office the Providers’ offices or under PC, Xxxxx, and Bandar’s the Providers’ control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 60 30 Paid Claims from submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all PC, 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s office Wiles’ offices or under PC, Xxxxx, and Bandar’s ’ control and applicable Medicare billing and state Medicaid 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. reimbursed. 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar EPIPG shall provide the IRO with a list of all PC, Xxxxx, and BandarEPIPG’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarEPIPG’s office or under PC, Xxxxx, and BandarEPIPG’s control and applicable Medicare Medicare, Tricare, and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. PC, Xxxxx, and Bandar x. Xxxxxx shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s Xxxxxx’x office or under PC, Xxxxx, and Bandar’s Xxxxxx’x control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. PC, Xxxxx, and Bandar x. Xxxxxx shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarNorman’s office or under PC, Xxxxx, and Bandar’s Xxxxxx’x control and applicable Medicare and state Medicaid 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.
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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar Skyline shall provide the IRO with a list of all PC, Xxxxx, and BandarSkyline’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarSkyline’s office or under PC, Xxxxx, and BandarSkyline’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar SPI shall provide the IRO with a list of all PC, Xxxxx, and BandarSPI’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarSPI’s office or under PC, Xxxxx, and BandarSPI’s control and applicable Medicare and state Medicaid 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.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 60 30 Paid Claims from submitted by or on behalf of 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. PC, Xxxxx, and Bandar MPG shall provide the IRO with a list of all PC, Xxxxx, and BandarMPG’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarMPG’s office or under PC, Xxxxx, and BandarMPG’s control and applicable Medicare and Medicare, state Medicaid 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.
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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar Springfield shall provide the IRO with a list of all PC, Xxxxx, and BandarSpringfield’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarSpringfield’s office or under PC, Xxxxx, and BandarSpringfield’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or behalf of 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. PC, Xxxxx, and Bandar Align shall provide the IRO with a list of all PC, Xxxxx, and BandarAlign’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarAlign’s office or under PC, Xxxxx, and BandarAlign’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar x. Xxxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarKhanna’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarKhanna’s office or under PC, Xxxxx, and BandarKhanna’s control and applicable Medicare and state Medicaid 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.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 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 60 30 Paid Claims from submitted by or on behalf of 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp. Xxxxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarKrentel’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarKrentel’s office or under PC, Xxxxx, and BandarKrentel’s control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 60 30 Paid Claims 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-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. PC, Xxxxx, Dakwa and Bandar HEAG shall provide the IRO with a list of all PC, Xxxxx, Dakwa’s and BandarHEAG’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, Dakwa’s and BandarHEAG’s office or under PC, Xxxxx, and BandarDakwa’s or HEAG’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar Foot Healers shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s Foot Healers’ office or under PC, Xxxxx, and Bandar’s Foot Healers’ control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar Practitioner shall provide the IRO with a list of all PC, Xxxxx, and BandarPractitioner’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarPractitioner’s office or under PC, Xxxxx, and BandarPractitioner’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims 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-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. PC, Xxxxx, and Bandar Practitioner shall provide the IRO with a list of all PC, Xxxxx, and BandarPractitioner’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarPractitioner’s office or under PC, Xxxxx, and BandarPractitioner’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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. PC, Xxxxx, and Bandar The Practice shall provide the IRO with a list of all PC, 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandarthe Practice’s office or under PC, Xxxxx, and Bandarthe Practice’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. PC, Xxxxx, and Bandar x. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s Xxxxx’x office or under PC, Xxxxx, and Bandar’s Xxxxx’x control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar Dia-Foot shall provide the IRO with a list of all PC, Xxxxx, and BandarDia-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 60 30 random numbers using RAT-RAT- STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarDia-Foot’s office or under PC, Xxxxx, and BandarDia-Foot’s control and applicable Medicare and state Medicaid 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.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.
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 60 30 Paid Claims from submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s Xxxxx’x office or under PC, Xxxxx, and Bandar’s Xxxxx’x control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 60 30 Paid Claims 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-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. PC, Xxxxx, and Bandar x. Xxxxxxxx Clinic shall provide the IRO with a list of all PC, Xxxxx, and BandarXxxxxxxx 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarXxxxxxxx Clinic’s office or under PC, Xxxxx, and BandarXxxxxxxx Clinic’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from 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-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. PC, Xxxxx, and Bandar GLML shall provide the IRO with a list of all PC, Xxxxx, and BandarGLML’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarGLML’s office or under PC, Xxxxx, and BandarGLML’s control and applicable Medicare and 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.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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar Xx. Xxxxx shall provide the IRO with a list of all PC, 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s Xx. Xxxxx’x office or any of the Cancer Centers or under PC, Xxxxx, and Bandar’s Xx. Xxxxx’x control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar Practitioner shall provide the IRO with a list of all PC, Xxxxx, and BandarPractitioner’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarPractitioner’s office or under PC, Xxxxx, and BandarPractitioner’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all PC, 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s office ’ offices or under PC, Xxxxx, and Bandar’s ’ control and applicable Medicare billing and state Medicaid 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. reimbursed. 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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar x. Xxxxxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarHanflink’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarHanflink’s office or under PC, Xxxxx, and BandarHanflink’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar x. Xxxx Clinic shall provide the IRO with a list of all PC, Xxxxx, and BandarXxxx 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarXxxx Clinic’s office or under PC, Xxxxx, and BandarXxxx Clinic’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar Center for Pain Management shall provide the IRO with a list of all PC, Xxxxx, and BandarCenter 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 60 30 random numbers using RAT-RAT- STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarCenter for Pain Management’s office or under PC, Xxxxx, and BandarCenter for Pain Management’s control and applicable Medicare and state Medicaid 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.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.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 60 30 Paid Claims from submitted by or on behalf of 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. PC, Xxxxx, Dr. Uradu and Bandar UTC shall provide the IRO with a list of all PC, Xxxxx, Dr. Uradu and BandarUTC’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, Dr. Uradu and BandarUTC’s office or under PC, Xxxxx, Dr. Uradu and BandarUTC’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar Princeton Pathology shall provide the IRO with a list of all PC, Xxxxx, and BandarPrinceton 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarPrinceton Pathology’s office or under PC, Xxxxx, and BandarPrinceton Pathology’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar The Covered Entities shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s the Covered Entities’ office or under PC, Xxxxx, and Bandar’s the Covered Entities’ control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar FHG shall provide the IRO with a list of all PC, Xxxxx, and BandarFHG’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarFHG’s office or under PC, Xxxxx, and BandarFHG’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar x. Xxxxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarGonzaga’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarGonzaga’s office or under PC, Xxxxx, and BandarGonzaga’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar APS shall provide the IRO with a list of all PC, Xxxxx, and BandarAPS’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarAPS’s office or under PC, Xxxxx, and BandarAPS’s control and applicable Medicare, Medicare Managed Care, Medicaid Managed Care, and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar CBHA shall provide the IRO with a list of all PC, Xxxxx, and BandarCBHA’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarCBHA’s office or under PC, Xxxxx, and BandarCBHA’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar OGCC shall provide the IRO with a list of all PC, Xxxxx, and BandarOGCC’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarOGCC’s office or under PC, Xxxxx, and BandarOGCC’s control and applicable Medicare Medicare, state Medicaid, and state 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 60 30 Paid Claims from submitted by or on behalf of 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Choudhary-Rolla Neurology shall provide the IRO with a list of all PC, Xxxxx, and BandarChoudhary-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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarChoudhary-Rolla Neurology’s office or under PC, Xxxxx, and BandarChoudhary- Rolla Neurology’s control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx, and Bandar -JCA shall provide the IRO with a list of all PC, Xxxxx, and Bandar-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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar-JCA’s office or under PC, Xxxxx, and Bandar-JCA’s control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar x. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarKumar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarKumar’s office or under PC, Xxxxx, and BandarKumar’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar x. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarGardi’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarGardi’s office or under PC, Xxxxx, and BandarGardi’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar x. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarQamar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarQamar’s office or under PC, Xxxxx, and BandarQamar’s control and applicable Medicare and state Medicaid 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.
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 IA, the IRO shall randomly select a sample of 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar LabTox shall provide the IRO with a list of all PC, Xxxxx, and BandarLabTox’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarLabTox’s office or under PC, Xxxxx, and BandarLabTox’s control and applicable Medicare and Medicare, state 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.
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 60 30 Paid Claims from submitted by or on behalf of 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.asp.xxxxx://xxx.xxx.xxx/ compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar MMW shall provide the IRO with a list of all PC, Xxxxx, and BandarMMW’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarMMW’s office or under PC, Xxxxx, and BandarMMW’s control and applicable Medicare and state Medicaid 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.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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar LFAC shall provide the IRO with a list of all PC, Xxxxx, and BandarLFAC’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarLFAC’s office or under PC, Xxxxx, and BandarLFAC’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar LHMC shall provide the IRO with a list of all PC, Xxxxx, and BandarLHMC’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarLHMC’s office or under PC, Xxxxx, and BandarLHMC’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims from submitted by or on behalf of 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-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
b. PC, Xxxxx, and Bandar xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. MBPC shall provide the IRO with a list of all PC, Xxxxx, and BandarMBPC’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. IRO. The randomly selected 60 30 Paid Claims shall will be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarMBPC’s office or under PC, Xxxxx, and BandarMBPC’s control and applicable Medicare billing and state Medicaid 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. reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.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 separate sample of 60 30 Paid Claims from submitted by 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat-
b. PC, x. Xxxxx, Integrated, Golden Management and Bandar any Covered Entity each shall provide the IRO with a list of all PC, Xxxxx, and Bandar’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandarthe applicable person/entity’s office or under PC, Xxxxx, and Bandarthe applicable person/entity’s control and applicable Medicare and state Medicaid 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 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.
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 60 30 Paid Claims from submitted by or on behalf of 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-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. PC, Xxxxx, and Bandar x. Xxxxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarBhayani’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarBhayani’s office or under PC, Xxxxx, and BandarBhayani’s control and applicable Medicare and Medicare, state Medicaid program program, or Medicaid 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.
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 60 30 Paid Claims from submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.
b. PC, Xxxxx, and Bandar x. Xxxxx shall provide the IRO with a list of all PC, Xxxxx, and BandarKelly’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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and BandarKelly’s office or under PC, Xxxxx, and BandarKelly’s control and applicable Medicare and state Medicaid 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 60 30 Paid Claims 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-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.at
b. PC, x. Xxxxx, Ltd., 215, and Bandar Xxxxxxxx shall provide the IRO with a list of all PCMonos, XxxxxLtd., 215, and Bandar’s 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PCMonos, XxxxxLtd., 215, and Bandar’s Xxxxxxxx’x office or under PCMonos, XxxxxLtd., 215, and Bandar’s Xxxxxxxx’x control and applicable Medicare and state Medicaid 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 60 30 Paid Claims 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-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. PC, Xxxxx, Xx. Xxx and Bandar Interventional Cardiology shall provide the IRO with a list of all PC, Xxxxx, Xx. Xxx and BandarInterventional 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 60 30 random numbers using RAT-STATS and then use the random numbers to identify the 60 30 Paid Claims in the Population that will be subject to review by the IRO.
c. The randomly selected 60 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, Xx. Xxx and BandarInterventional Cardiology’s office or under PC, Xxxxx, Xx. Xxx and BandarInterventional Cardiology’s control and applicable Medicare and state Medicaid 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.
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Samples: Integrity Agreement
