Common use of Quarterly Claims Sample Clause in Contracts

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌ b. I&L shall provide the IRO with a list of all I&L’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s office or under I&L’s control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) the prescription drugs furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug), and (3) whether the claims were correctly billed and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Xx. Xxxxxx-Xxxxxx D.P.M. during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT-‌ STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌ b. I&L Xx. Xxxxxx-Xxxxxx D.P.M. shall provide the IRO with a list of all I&LXx. Xxxxxx-Xxxxxx D.P.M.’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LXx. Xxxxxx-Xxxxxx D.P.M.’s office or under I&LXx. Xxxxxx-Xxxxxx D.P.M.’s control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary and appropriately documented, and (3) whether the claims were claim was correctly billed coded, submitted, and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.reimbursed.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L 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 is‌ currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌ b. I&L x. Xxxxxx shall provide the IRO with a list of all I&L’s Xxxxxx’x Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s Xxxxxx’x office or under I&L’s Xxxxxx’x control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) the prescription drugs furnished by I&L Xxxxxx were dispensed according to a valid prescription,‌‌ prescription, (2) I&L Xxxxxx maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug), and (3) whether the claims were correctly billed and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L Xxxxxx maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.refill.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Xxxxx Xxxxxxxx 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. I&L x. Xxxxx Pharmacy shall provide the IRO with a list of all I&LXxxxx Pharmacy’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LXxxxx Pharmacy’s office or under I&LXxxxx Pharmacy’s control (including but not limited to, an electronic or hard copy of the prescription, proof of delivery of the prescription, any documentation relating to the initiation of a prescription refill as required by the payor for the prescription, and any documentation related to the collection or waiver of a cost-sharing amount) and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) the prescription drugs furnished by I&L Xxxxx Pharmacy were dispensed according to a valid prescription,‌‌ prescription, (2) I&L Xxxxx Pharmacy maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drugrefills), and (3) whether the claims Paid Claims were correctly billed and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (34) any required steps to initiate and process a prescription refillXxxxx Pharmacy appropriately collected or waived cost-sharing amounts. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B 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.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L DLDC during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. I&L DLDC shall provide the IRO with a list of all I&LDLDC’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO.‌‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LDLDC’s office or under I&LDLDC’s control and applicable Medicare and state Medicaid program requirements and applicable state Board practice guidelines, including those promulgated by the American Society for Gastrointestinal Endoscopy and the American College of Pharmacy requirements Gastroenterology, to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary, medically appropriate, and (3) appropriately documented, and whether the claims were claim was correctly billed coded, submitted, and reimbursed. For each Paid Claim reviewedcolonoscopy procedures in the Quarterly Claims Sample, the IRO should verify that I&L maintained documentation ofQuarterly Claims Review shall also determine whether DLDC recorded the following quality indicator data in the patient’s record: (1) the prescription length of time since previous colonoscopy; indication for colonoscopy, diagnostic or order for the drug dispensedscreening; (2) the delivery quality of bowel preparation; visualization of the drugcecum through notation of landmarks, including photo-documentation; adenoma detection; withdrawal time; any complications; and (3) any required steps to initiate and process a prescription refill.clinical recommendations.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L 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. I&L xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all I&LXxxxx’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. IRO. The IRO shall review the randomly selected 30 Paid Claims for (1) correct coding, submission, and reimbursement, and (2) medical necessity, appropriateness of case selection, quality of procedure, execution, proper response to intraprocedural problems, accurate assessment of procedure outcome, and appropriateness of procedure management. The Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s office from Anand or under I&LXxxxx’s control and applicable Medicare regulations and state Medicaid program requirements guidance, including but not limited to applicable billing and applicable state Board coding regulations and guidance and the established practice guidelines and generally accepted standards practice described by the American College of Pharmacy requirements Cardiology, to determine whether: (1) the prescription drugs furnished by I&L were dispensed according to a valid prescription,‌‌ whether each claim was correctly coded, submitted, and reimbursed, and (2) I&L maintained appropriate documentation of a valid prescription for whether each drug dispensed (including any refills of such drug), procedure was medically necessary and (3) whether the claims were correctly billed and reimbursedappropriate. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims and Cardiac Procedures Review Report). The Quarterly Claims and Cardiac Procedures Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌and Cardiac Procedures Review.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L OC and Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. I&L OC and Xxxxxx shall provide the IRO with a list of all I&L’s OC and Xxxxxx’x Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s OC and Xxxxxx’x office or under I&L’s OC and Xxxxxx’x control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary and appropriately documented, and (3) whether the claims were claim was correctly billed coded, submitted, and reimbursed. For each The IRO also shall review the Quarterly Inventory Reconciliation Report prepared by OC and Xxxxxx for the quarter under review, to verify that the dosage amounts of any administered pharmaceuticals on the Paid Claim reviewed, Claims reviewed by the IRO should verify that I&L maintained documentation of: (1) are consistent with the prescription or order for the drug dispensed; (2) the delivery available inventory of the drug; and (3) any required steps to initiate and process a prescription refillsuch administered pharmaceuticals. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B 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.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Xxxxx Pharmacy during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s 's Office of Audit Services’ ' Statistical Sampling Software, also known as RAT-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌‌ Xxxxxx Xxxxx Professional Pharmacy, Inc. dlbla Xxxxx Pharmacy, Gwy Xxxx, and Xxxxxx X. Xxxxxxx Integrity Agreement- Appendix B b. I&L x. Xxxxx Pharmacy shall provide the IRO with a list of all I&L’s Xxxxx Pharmacy's Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO.‌‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s Xxxxx Pharmacy's office or under I&L’s Xxxxx Pharmacy's control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary and appropriately documented, and (3) whether the claims were claim was correctly billed coded, submitted, and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.reimbursed.‌‌‌‌‌‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B 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.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L ofNorthwest ENT during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s ' s Office of Audit Services’ ' Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌RAT-‌ xxxxx://xx x.xxx.xxx/xxxxxxxxxx/xxx-xxxxx/xxxxx.xxx. Northwest ENT IA Appenaix 8 b. I&L Northwest ENT shall provide the IRO with a list of all I&L’s Northwest ENT's Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s Northwest ENT's office or under I&L’s Northwest ENT's control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary and appropriately documented, whether the claim was correctly coded, submitted, and (3) reimbursed, and, for procedures involving medical devices, whether the claims devices were correctly billed used safely and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.appropriately.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B below 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.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Provider during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. I&L Provider shall provide the IRO with a list of all I&LProvider’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LProvider’s office or under I&LProvider’s control and applicable Medicare and state Medicaid program requirements and applicable state State Board of Pharmacy requirements to determine whether: (1) the whether each prescription drugs furnished by I&L were was dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate prescription, whether documentation of a valid the prescription for each drug dispensed (including any refills of such drug)refills) is maintained and appropriately documented, and (3) whether the claims were claim was correctly billed submitted, and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L Provider maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B 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.

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L LCPCC during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-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. I&L LCPCC shall provide the IRO with a list of all I&LLCPCC’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌IRO.‌‌‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LLCPCC’s office or under I&LLCPCC’s control and applicable Medicare and state Medicaid program requirements and applicable state State Board of Pharmacy requirements to determine whether: (1) the whether each prescription drugs furnished by I&L were was dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate prescription, whether documentation of a valid the prescription for each drug dispensed (including any refills of such drug)refills) is maintained and appropriately documented, and (3) whether the claims were claim was correctly billed submitted and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L LCPCC maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.refill.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT-‌ 1 The overpayment definition and paid claim definition should be expanded to include other Federal health care programs if claims to those payors were at issue in the underlying case or represent a significant portion of the Practitioner’s payor mix.‌ STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌at‌‌‌ xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. b. I&L Xxxxxx shall provide the IRO with a list of all I&LHanora’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&LHanora’s office or under I&LHanora’s control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) whether the prescription drugs items and services furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug)medically necessary and appropriately documented, and (3) whether the claims were claim was correctly billed coded, submitted, and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill.reimbursed.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌

Quarterly Claims Sample. a. Within 15 days following the end of each three-month period during the term of the this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L Xxxxxxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌ b. I&L xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxxxxxxx shall provide the IRO with a list of all I&L’s Xxxxxxxxxx’x Paid Claims for the three-three- month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. IRO. The IRO shall review the randomly selected 30 Paid Claims for (1) correct coding, submission, and reimbursement, and (2) medical necessity, appropriateness of case selection, quality of procedure, execution, proper response to intraprocedural problems, accurate assessment of procedure outcome, and appropriateness of procedure management. The Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s office from Chatterjee or under I&L’s Xxxxxxxxxx’x control and applicable Medicare regulations and state Medicaid program requirements guidance, including but not limited to applicable billing and applicable state Board coding regulations and guidance and the established practice guidelines and generally accepted standards practice described by the American College of Pharmacy requirements Cardiology, to determine whether: (1) the prescription drugs furnished by I&L were dispensed according to a valid prescription,‌‌ whether each claim was correctly coded, submitted, and reimbursed, and (2) I&L maintained appropriate documentation of a valid prescription for whether each drug dispensed (including any refills of such drug), procedure was medically necessary and (3) whether the claims were correctly billed and reimbursedappropriate. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B C below (Quarterly Claims and Cardiac Procedures Review Report). The Quarterly Claims and Cardiac Procedures Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌and Cardiac Procedures Review.