Common use of Repayment of Identified Overpayments Clause in Contracts

Repayment of Identified Overpayments. PPOA shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA shall repay that amount at the mean point estimate as calculated by the IRO. PPOA shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA Providence shall repay within 60 days the any Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA Providence determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA Providence shall repay that amount at the mean point estimate as calculated by the IRO. PPOA Providence shall make available to OIG all documentation that reflects the refund of the any Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA Providence to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the that payor.

Repayment of Identified Overpayments. PPOA APS shall repay within 60 days the Overpayment(s) any Overpayments identified by the IRO in the Quarterly Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA APS determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA APS shall repay that amount at the mean point estimate as calculated by the IRO. PPOA APS shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Quarterly Claims Review Sample (and any related work papers) received from PPOA APS to the appropriate Medicare or state Medicaid program contractor or Medicare Managed Care or Medicaid Managed Care company for appropriate follow up by the that payor.

Repayment of Identified Overpayments. PPOA UHealth shall repay within 60 days the any Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA UHealth determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA UHealth shall repay that amount at the mean point estimate as calculated by the IRO. PPOA UHealth shall make available to OIG all documentation that reflects the refund of the any Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA UHealth to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the that payor.

Repayment of Identified Overpayments. PPOA Apria shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA Apria determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA Apria shall repay that amount at the mean point estimate as calculated by the IRO. PPOA Apria shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA Apria to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA Pentec shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA Pentec determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA Pentec shall repay that amount at the mean point estimate as calculated by the IRO. PPOA Pentec shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA Pentec to the appropriate Medicare or applicable state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA Agendia shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA Agendia determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA Agendia shall repay that amount at the mean point estimate as calculated by the IRO. PPOA Agendia shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA Agendia to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA SNAP shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA SNAP determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA SNAP shall repay that amount at the mean point estimate as calculated by the IRO. PPOA SNAP shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA SNAP to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA CRC shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA CRC determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA CRC shall repay that amount at the mean point estimate as calculated by the IRO. PPOA CRC shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA CRC to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA AAMC shall repay within 60 days the any Overpayment(s) identified by the IRO in the either Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA AAMC determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA AAMC shall repay that amount at the mean point estimate as calculated by the IRO. PPOA AAMC shall make available to OIG all documentation that reflects the refund of the any Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA AAMC to the appropriate Medicare Medicare, state Medicaid, or state Medicaid TRICARE program contractor for appropriate follow up by the that payor.

Repayment of Identified Overpayments. PPOA TPRC shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and or Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA TPRC determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA TPRC shall repay that amount at the mean point estimate as calculated by the IRO. PPOA TPRC shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA TPRC to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA SMMC shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review Sample, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA SMMC determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA SMMC shall repay that amount at the mean point estimate as calculated by the IRO. PPOA SMMC shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PPOA SMMC to the appropriate Medicare or state Medicaid program contractor for appropriate follow up by the payor.

Repayment of Identified Overpayments. PPOA THM shall repay within 60 days the Overpayment(s) identified by the IRO in the Claims Review SampleSamples, in accordance with the requirements of 42 U.S.C. § 1320a-7k(d) and any applicable regulations and Centers for Medicare and Medicaid Services (CMS) guidance (the “CMS overpayment rule”). If PPOA THM determines that the CMS overpayment rule requires that an extrapolated Overpayment be repaid, PPOA THM shall repay that amount at the mean point estimate as calculated by the IRO. PPOA THM shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. OIG, in its sole discretion, may refer the findings of the Claims Review Sample Samples (and any related work papers) received from PPOA THM to the appropriate Medicare or state Medicaid program or Medicaid managed care program contractor for appropriate follow up by the payor.