Common use of Systems Review Clause in Contracts

Systems Review. If the Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFX’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the RMC’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixRMC’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXRMC’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Provider’s Discovery Sample identifies an Error Rate of 5% or greater, Orthofixthe Provider’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXthe Provider’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); ; b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Rehab’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixRehab’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXRehab’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Orbit’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixOrbit’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXOrbit’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Discovery Sample identifies an Error Rate of 5% or greater, OrthofixCCH’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXCCH’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, ; the process by which claims are coded, ; safeguards to ensure proper coding, claims submission submission, and billing; and procedures to identify and correct inaccurate coding and billing);; and b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the MCCG’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixMCCG’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXMCCG’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Xxxxxxx’x Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s Xxxxxxx’x IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFX’s Xxxxxxx’x billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for For each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the The Tribes’ Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s The Tribes’ IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. (a) a review of OFX’s The Tribes’ billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing);billing);‌ b. (b) for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.claim.‌

Systems Review. If the a Discovery Sample identifies an Error Rate of 5% or greater, OrthofixMaxim’s IRO shall also conduct a Systems ReviewReview for that region. The Systems Review shall consist of the following: a. a review of OFXMaxim’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Mid Xxxxxx’x Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s Mid Xxxxxx’x IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFX’s Xxx Xxxxxx’x billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, ; the process by which claims are coded, ; safeguards to ensure proper coding, claims submission submission, and billing; and procedures to identify and correct inaccurate coding and billing);; and b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Providers’ Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s the Providers’ IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFX’s the Providers’ billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the La Fuente’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixLa Fuente’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXXx Xxxxxx’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Medicus’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixMedicus’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXMedicus’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Trans-Star’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixTrans-Star’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXTrans-Star’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the PALMS’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixPALMS’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXPALMS’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Home Bound’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixHome Bound’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXHome Bound’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the Ho Medical’s Discovery Sample identifies an Error Rate of 5% or greater, OrthofixHo Medical’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXHo Medical’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for For each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the a Discovery Sample identifies an Error Rate of 5% or greater, OrthofixSound’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXSound’s medical record documentation, billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, medical record documentation, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing); b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.

Systems Review. If the any Discovery Sample identifies an Error Rate of 5% or greater, Orthofix’s the IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of OFXthe applicable Baptist hospital’s billing and coding systems and processes relating to claims submitted to Federal health care programs (including, but not limited to, the operation of the billing system, the process by which claims are coded, safeguards to ensure proper coding, claims submission and billing; and procedures to identify and correct inaccurate coding and billing);; and, b. for each claim in the Discovery Sample and Full Sample that resulted in an Overpayment, the IRO shall review the system(s) and process(es) that generated the claim and identify any problems or weaknesses that may have resulted in the identified Overpayments. The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the claim.