Common use of Systems Review Clause in Contracts

Systems Review. If Tri-County’s Discovery Sample identifies an Error Rate of 5% or greater, Tri-County’s IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of Tri-County’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 Tri-Countyeither of Toccoa’s Discovery Sample Samples identifies an Error Rate of 5% or greater, Tri-CountyToccoa’s IRO shall also conduct a Systems ReviewReview relating to that Discovery Sample. The Systems Review shall consist of the following: a. a review of Tri-CountyToccoa’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);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.claim.‌

Systems Review. If Tri-County’s the CareAll Entities’ Discovery Sample identifies an Error Rate of 5% or greater, Tri-County’s the CareAll Entities’ IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of Tri-County’s the CareAll Entities’ 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 Tri-County’s either of Xxxxxxxx’x Discovery Sample identifies Samples identify an Error Rate of 5% or greater, Tri-County’s Xxxxxxxx’x IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of Tri-County’s Xxxxxxxx’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 each claim in the Discovery Sample Sample(s) and Full Sample Sample(s) 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 Tri-County’s the DIG Entities’ Discovery Sample identifies an Error Rate of 5% or greater, Tri-County’s the DIG Entities’ IRO shall also conduct a Systems Review. The Systems Review shall consist of the following: a. a review of Tri-County’s the DIG Entities’ 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 Samples and Full Sample Samples 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.