Common use of Systems Review Clause in Contracts

Systems Review. If the Discovery Sample identifies an Error Rate of 5% or greater, CCH’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCH’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.

Systems Review. If the RMC’s Discovery Sample identifies an Error Rate of 5% or greater, CCHRMC’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHRMC’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 Orbit’s Discovery Sample identifies an Error Rate of 5% or greater, CCHOrbit’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHOrbit’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 Provider’s Discovery Sample identifies an Error Rate of 5% or greater, CCHthe Provider’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHthe 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, 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 Rehab’s Discovery Sample identifies an Error Rate of 5% or greater, CCHRehab’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHRehab’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 Discovery Sample identifies an Error Rate of 5% or greater, CCHOrthofix’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHOFX’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 Medicus’s Discovery Sample identifies an Error Rate of 5% or greater, CCHMedicus’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHMedicus’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, CCHMCCG’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHMCCG’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 PALMS’s Discovery Sample identifies an Error Rate of 5% or greater, CCHPALMS’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHPALMS’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 Home Bound’s Discovery Sample identifies an Error Rate of 5% or greater, CCHHome Bound’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHHome 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, 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 any Discovery Sample identifies an Error Rate of 5% or greater, CCH’s the IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCHthe 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, 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, CCH’s the Providers’ IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of CCH’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, 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 a Discovery Sample identifies an Error Rate of 5% or greater, CCHMaxim’s IRO shall also conduct a Systems ReviewReview for that region. The Systems Review shall consist of the following: a. a review of CCHMaxim’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.