Systems Review Report. LifePoint shall prepare a report based upon each Systems Review performed ("Systems Review Report"). The Systems Review Report shall include LifePoint's findings and supporting rationale regarding:
Systems Review Report. The Peer Review Consultant shall prepare a report based on the Systems Review. The Systems Review Report shall include the Peer Review Consultant’s findings and supporting rationale regarding:
a. its assessment of KDMC’s peer review policies and procedures, medical staff credentialing and privileging, and medical staff training and discipline based on the Systems Review; and
b. any recommendations the Peer Review Consultant may have to improve any of these systems, operations, and processes (Peer Review Recommendations). The Systems Review Report shall be delivered to KDMC within 60 days of the end of the first Reporting Period. A copy of the Systems Review Report shall be provided to the OIG in the First Annual Report as required by Section V.B of the CIA.
Systems Review Report. The Peer Review Consultant shall prepare a report based on the Systems Review. The Systems Review Report shall include the Peer Review Consultant’s findings and supporting rationale regarding:
a. the strengths and weaknesses in Allegiance’s peer review policies and procedures, medical staff credentialing and privileging, and medical staff training and discipline based on the Systems Review;
b. the Peer Review Consultant’s conclusions based on the Systems Review; and
c. any recommendation the Peer Review Consultant may have to improve any of these systems, operation, and processes (Peer Review Recommendations). The Systems Review Report shall be delivered to Allegiance within 60 days of the end of the first Reporting Period. A copy of the Systems Review Report shall be provided to the OIG in the First Annual Report as required by Section V.B. of the CIA.
Systems Review Report. For each Reporting Period for which a Systems Review is performed hereunder, the IRO shall prepare a report based upon the Systems Review. This report may be (but is not required to be) combined with the report for the Transactions Review described in Section III below, and shall include the following: (Relating to Systems Review — Part I)
1. A description of the systems, processes, policies, and procedures in place to track, gather, and account for price terms, contract terms, and transactions with Biovail customers that are relevant to the calculation and reporting of AMP, BP, and ASP, including, but not limited to:
a) The computer or other relevant systems (including the source systems and any other information systems, as applicable) used to track data for and to calculate and report AMP, BP, and ASP;
b) The information input into Biovail’s relevant computer or other systems used to calculate AMP, BP, and ASP;
c) The system logic or decisional rationale used to determine which customers are included or excluded for purposes of calculating AMP, BP, and ASP;
d) The system logic or decisional rationale used to determine whether contract terms, discounts, rebates and all other relevant transactions with Biovail customers are included or excluded when calculating AMP, BP, and ASP;
e) The system logic or decisional rationale used to determine whether and in what manner estimates of prices, discounts and other amounts are made for purposes of determining AMP, BP, and ASP; and
f) Biovail’s policies and procedures in examining system reports for variations that require critical evaluation, including the basis on which variations, exceptions, or outliers are identified, and the follow-up actions taken in response.
2. A description of the documentation, information, and systems reviewed, and the personnel interviewed, if any, including a description of the following:
a) Biovail’s inquiries to CMS regarding the calculation of AMP, BP or ASP and any responses to those inquiries;
b) Biovail’s systems and practices for reporting AMP, BP, and ASP to CMS as required by the Medicaid Drug Rebate program and the Medicare Program; and
c) Biovail’s systems and practices for reporting any adjustments to AMP, BP, or ASP or additional information relating to the submissions.
3. Observations, findings, and recommendations for any improvements to Biovail’s systems, processes, policies, and procedures, including any changes recommended in order to improve compliance with the requ...
Systems Review Report. The IRO shall prepare a Systems Review Report for each Systems Review that includes the following information:
1. a description of Xxxxxxx’s billing and coding system(s) including the identification, by position description, of the personnel involved in coding and billing;
2. a description of Lincare’s systems, processes, policies, and procedures for the submission of claims to the Medicare program and to any MAO for oxygen equipment rental and non-invasive home ventilators (or any claim types selected for review by the OIG in the second and subsequent Reporting Periods);
3. a description of the controls in place to ensure that items and services furnished by Lincare are correctly coded, appropriately documented, and medically necessary, including but not limited to, controls in place to ensure that (a) Lincare is not being paid by the Medicare program or any MAO for oxygen equipment rentals beyond any applicable caps for periods in excess of 36 months, and (b) Lincare is documenting in-home checks and other monitoring by Lincare of non-invasive home ventilator equipment functionality and patient usage;
Systems Review Report. The IRO shall prepare a Systems Review Report for each Systems Review that includes the following information:
1. a description of the documentation (including policies) reviewed and any personnel interviewed;
2. a detailed description of Advanced Bionics’s systems, policies, processes, and procedures relating to the items identified in Sections A.1-4 above, including a general description of Advanced Bionics’s control and accountability systems (e.g., documentation and approval requirements, and tracking mechanisms) and written policies regarding the Reviewed Policies and Procedures;
3. a description of the manner in which the control and accountability systems and the written policies relating to the items identified in Sections A.1-4 above are made known or disseminated within Advanced Bionics;
Systems Review Report. The IRO shall prepare a Systems Review Report for each Systems Review that includes the following information:
1. a description of the documentation (including policies) reviewed and any personnel interviewed;
2. a detailed description of Biotronik’s systems, policies, processes, and procedures relating to the items identified in Sections B.1-15 above, including a general description of Biotronik’s control and accountability systems (e.g., documentation and approval requirements, and tracking mechanisms) and written policies regarding the Reviewed Policies and Procedures;
3. a description of the manner in which the control and accountability systems and the written policies relating to the items identified in Sections B.1-15 above are made known or disseminated within Biotronik;
4. findings and supporting rationale regarding any weaknesses in Biotronik’s systems, processes, policies, and procedures relating to the Reviewed Policies and Procedures, if any; and
5. recommendations to improve any of the systems, policies, processes, or procedures relating to the Reviewed Policies and Procedures, if any.
Systems Review Report. The IRO shall prepare a Systems Review Report for each Systems Review that includes the following information:
1. a description of Xxxxxxx’s billing and coding system(s) including the identification, by position description, of the personnel involved in coding and billing;
2. a description of Lincare’s systems, processes, policies, and procedures for the submission of claims to the Medicare program and to any MAO for oxygen equipment rental and non-invasive home ventilators (or any claim types selected for review by the OIG in the second and subsequent Reporting Periods);
3. a description of the controls in place to ensure that items and services furnished by Lincare are correctly coded, appropriately documented, and medically necessary, including but not limited to, controls in place to ensure that (a) Lincare is not being paid by the Medicare program or any MAO for oxygen equipment rentals beyond any applicable caps for periods in excess of 36 months, and (b) Lincare is documenting in-home checks and other monitoring by Lincare of non-invasive home ventilator equipment functionality and patient usage;
4. the IRO’s recommendations for improvements to Xxxxxxx’s billing and coding system or to Lincare’s controls for ensuring that all items and services billed to the Medicare program and MAOs by Lincare are correctly coded, appropriately documented (including documentation of in-home checks and other monitoring by Lincare of non-invasive home ventilator equipment functionality and patient usage), appropriately billed and paid within Medicare and, if applicable, MAO 36-month payment limits for oxygen equipment rentals, and medically necessary, based on the findings of the Systems Review; and
5. the names and credentials of the individuals who performed the Systems Review.
Systems Review Report. The IRO shall prepare a report based upon both Parts 1 and 2 of each Systems Review. For each of the topics identified in Section II.A above, the report shall include the following items:
1. A description of the methodology, systems, processes, policies, and practices in place to calculate, track, gather, and account for price terms, contract terms, and transactions with Elan customers that are relevant to the calculation and reporting of AMP, Best Price, and ASP, including, but not limited to:
a. The computer or other relevant systems (including the source systems and any other information systems, as applicable) used to track data for and to calculate and report AMP, Best Price, and ASP;
b. The information input into Elan’s relevant computer or other systems used to calculate AMP, Best Price and ASP;
c. The system logic or decisional rationale used to determine which customers are included or excluded for purposes of calculating AMP, Best Price, and ASP;
d. The system logic or decisional rationale used to determine whether contract terms, discounts, rebates and all other relevant transactions with Elan customers are included or excluded when calculating AMP, Best Price, and ASP; and
e. Elan’s policies and practices in examining system reports for variations that require critical evaluation, including the basis on which variations, exceptions, or outliers are identified, and the follow up actions taken in response.
2. A description of the documentation, information, and systems reviewed, and the personnel interviewed, if any, including a description of the following:
a. Elan’s inquires to CMS or any State Medicaid program regarding the calculation of AMP, Best Price, and/or ASP and any responses to those inquiries;
b. Elan’s systems and practices for reporting AMP, Best Price, and ASP to CMS as required by the Medicaid Drug Rebate program and the Medicare Part B program; and
c. Elan’s systems and practices for reporting any adjustments or additional information related to the AMP, Best Price, and ASP submissions.
Systems Review Report. The IRO shall prepare a report based upon each Systems Review. For each of the Reviewed Policies and Procedures identified in Section II.A above, the report shall include the following items:
1. a description of the documentation (including policies) reviewed and any personnel interviewed; Spectranetics Corporate Integrity Agreement
