Examples of Paid claims in a sentence
Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Provider differed from what should have been the correct coding.
The first set of Paid Claims selected shall be used for the Claims Review Sample (i.e., it is not permissible to generate more than one list of random samples and then select one for use).
The IRO shall review the Paid Claims based on Provider’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample).
The IRO shall request all documentation required for its review of the Paid Claims in the Claims Review Sample and Provider shall furnish such documentation to the IRO prior to the IRO initiating its review of the Claims Review Sample.