REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Bhayani shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Bhayani that includes a summary of all current and prior engagements between Bhayani and the IRO;
3. a copy of the search result print screens demonstrating that Bhayani has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;
4. a copy of any certifications from Bhayani and the third-party billing company required by Section III.H (if applicable);
5. a list of all of Bhayani’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
6. a certification by Bhayani that: (a) he or she has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his or her knowledge, except as otherwise described in the Implementation Report, Bhayani is in compliance with all of the requirements of this IA;
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xx. Xxxxx shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Xx. Xxxxx and the Cancer Centers;
3. a copy of the search result print screens demonstrating that Xx. Xxxxx has screened all Covered Persons against the Exclusion List, as required by Section III.E, within 30 days of the Effective Date;
4. a copy of any certifications from Xx. Xxxxx and the third party billing company required by Section III.I (if applicable);
5. a list of all of Xx. Xxxxx’x and the Cancer Centers’ locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
6. a certification by Xx. Xxxxx that: (a) he has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his knowledge, except as otherwise described in the Implementation Report, Xx. Xxxxx and the Cancer Centers are in compliance with all of the requirements of this IA; (c) he has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he understands that the certification is being provided to and relied upon by the United States
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xxxxxxx shall submit a written report to OIG summarizing the status of his implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Xxxxxxx;
3. a copy of the documentation demonstrating that Xxxxxxx has screened all Covered Persons against the Exclusion List, as required by section III.D, within 30 days of the Effective Date;
4. a copy of any certifications from Xxxxxxx and the third party billing company required by Section III.H (if applicable);
5. a list of all of Solomon’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xx. Xxxxxx shall submit a written report to OIG summarizing the status of his implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Xx. Xxxxxx that includes a summary of all current and prior engagements between Xx. Xxxxxx and the IRO;
3. a copy of the search result print screens demonstrating that Xx. Xxxxxx has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;
4. a copy of any certifications from Xx. Xxxxxx and the third-party billing company required by Section III.H;
5. a list of all of Xx. Xxxxxx’x locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
6. a certification by Xx. Xxxxxx that: (a) he has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his knowledge, except as otherwise described in the Implementation Report, Xx. Xxxxxx is in compliance with all of the requirements of this IA; (c) he has reviewed the Implementation Report and has made a reasonable inquiry regarding its content and believes that the information is accurate and truthful; and (d) he understands that the certification is being provided to and relied upon by the United States
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Gonzaga shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. the name, address, phone number, and position description of the Compliance Contact required by Section III.A, and a summary of any other noncompliance job responsibilities;
2. a list of the Policies and Procedures required by Section III.B;
3. a copy of the notice required by Section III.C, a description of where the notice is posted, and the date the notice was posted;
4. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Gonzaga that includes a summary of all current and prior engagements between Gonzaga and the IRO;
5. a copy of the search result print screens demonstrating that Gonzaga has screened all Covered Persons against the Exclusion List as required by Section III.F within 30 days of the Effective Date;
6. a copy of Gonzaga’s policies and procedures regarding the identification, quantification and repayment of Overpayments required by Section III.H;
7. a copy of any certifications from Gonzaga and the third party billing company required by Section III.J (if applicable);
8. a list of all of Gonzaga’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xx. Xxx and Interventional Cardiology shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Xx. Xxx and Interventional Cardiology that includes a summary of all current and prior engagements between Xx. Xxx and Interventional Cardiology and the IRO;
3. a copy of the search result print screens demonstrating that Xx. Xxx and Interventional Cardiology has screened all Covered Persons against the Exclusion List, as required by Section III.D, within 30 days of the Effective Date;
4. a copy of any certifications from Xx. Xxx and Interventional Cardiology and the third-party billing company required by Section III.H (if applicable);
5. a list of all of Xx. Xxx and Interventional Cardiology’s locations (including locations and mailing addresses), the corresponding name under which each location is doing business, and each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s); and
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xx. Xxxxxx-Xxxxxx D.P.M. shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; and (d) a certification from the IRO regarding its professional independence and objectivity with respect to Xx. Xxxxxx-Xxxxxx D.P.M.;
3. a copy of the documentation demonstrating that Xx. Xxxxxx-Xxxxxx
REPORT, IRO REPORTS AND ANNUAL REPORTS.
A. Implementation Report Within 90 days after the Effective Date, Xx. Xxxxxxxx shall submit a written report to OIG summarizing the status of its implementation of the requirements of this IA (Implementation Report). The Implementation Report shall, at a minimum, include:
1. a copy of the notice required by Section III.A, a description of where the notice is posted, and the date the notice was posted;
2. the following information regarding the one hour of training required by Section III.B to be completed within 60 days of the Effective Date: a copy of the training program registration for each Covered Person who completed the training, the name of the training course, the name of the entity that provided the training, the location, date and length of the training; and a training program brochure or other materials from the training program or training program sponsor that describe the content of the training program. A copy of all training materials shall be made available to OIG upon request;
3. the following information regarding the IRO: (a) identity, address, and phone number; (b) a copy of the engagement letter; (c) information to demonstrate that the IRO has the qualifications outlined in Appendix A to this IA; (d) a summary and description of any and all current and prior engagements and agreements between Xx. Xxxxxxxx and the IRO; and (e) a certification from the IRO regarding its professional independence and objectivity with respect to Xx. Xxxxxxxx;
4. a copy of the documentation demonstrating that Xx. Xxxxxxxx has screened all Covered Persons against the Exclusion Lists, as required by section III.D, within 30 days of the Effective Date;
5. a copy of any certifications from Xx. Xxxxxxxx and the third party billing company required by Section III.H (if applicable);
6. a list of all of Xx. Xxxxxxxx’x locations (including locations and mailing addresses), the corresponding name under which each location is doing business, the corresponding phone numbers and fax numbers, each location’s Medicare and state Medicaid program provider number(s), and/or supplier number(s), and the name and address of each Medicare and state Medicaid program contractor to which Xx. Xxxxxxxx currently submits claims; and
7. a certification by Xx. Xxxxxxxx that: (a) he has reviewed the IA in its entirety, understands the requirements described within, and maintains a copy for reference; (b) to the best of his knowledge, except as otherwise described in the Impleme...
REPORT, IRO REPORTS AND ANNUAL REPORTS
