Examples of Covered Facility in a sentence
A description of the Population for each Dignity Health Covered Facility subject to the Claims Review.
The IRO shall randomly select and review a sample of 100 Paid Claims (each constituting a “Discovery Sample”) at each Dignity Health Covered Facility selected for review.
If the Discovery Sample at any Covered Facility selected for review indicates that the Error Rate is 5% or greater, the IRO shall select an additional sample of Paid Claims from that Covered Facility (Full Sample) using commonly accepted sampling methods.
At least 60 days prior to the end of the Third and Fifth Reporting Periods, Dignity Health shall provide OIG and the IRO with the following information for each Dignity Health Covered Facility for the prior fiscal year: (1) Total dollar amount of Paid Claims for inpatient discharges; and (2) the percentage of Federal health care program reimbursement received by the Dignity Health Covered Facility compared to the Covered Facility’s total revenue.
If Dignity Health’s Discovery Sample at any Dignity Health Covered Facility Selected for review identifies an Error Rate of 5% or greater, Dignity Health’s IRO shall also conduct a Systems Review for that Dignity Health Covered Facility.