Common use of Discovery Samples Clause in Contracts

Discovery Samples. The IRO shall conduct two Discovery Samples, reviewing a total of 200 randomly selected Paid Claims (Discovery Samples). In the first Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Medicare Population. In the second Discovery Sample the IRO shall randomly select and review a sample of 100 Paid Claims from the Focus State Medicaid Population. In both Discovery Samples the Paid Claims shall be reviewed based on the supporting documentation available at ▇▇▇▇▇▇▇▇’▇ office or under ▇▇▇▇▇▇▇▇’▇ control and applicable billing and coding regulations and guidance to determine whether the claim was correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for both Discovery Samples is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, ▇▇▇▇▇▇▇▇ should, as appropriate, further analyze any errors identified in the Discovery Samples. ▇▇▇▇▇▇▇▇ recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Samples or any other segment of the universe.)

Discovery Samples. The IRO shall conduct randomly select and review two Discovery Samples, reviewing a total samples of 200 randomly selected 100 Paid Claims (Discovery Samples). In the first One Discovery Sample the IRO shall randomly select and review a sample of 100 is for Paid Claims drawn from all laboratory claims, and the Medicare Population. In the second other Discovery Sample the IRO shall randomly select and review a sample of 100 is for Paid Claims drawn from the Focus State Medicaid Populationall service lines within which physicians participate in 21st Century’s ancillary bonus pools. In both Discovery Samples the The Paid Claims shall be reviewed based on the supporting documentation available at ▇▇▇▇▇▇▇▇’▇ 21st Century’s office or under ▇▇▇▇▇▇▇▇’▇ control 21st Century’s control, and the applicable billing coverage, billing, coding, and coding regulations and medical necessity requirements, regulations, and/or guidance to determine whether the claim was items and services provided were medically necessary, and whether the claims were correctly coded, submitted, and reimbursed. If the Error Rate (as defined above) for both each Discovery Samples Sample is less than 5%, no additional sampling is required, nor is the Systems Review required. (Note: The guidelines listed above do not imply that this is an acceptable error rate. Accordingly, ▇▇▇▇▇▇▇▇ 21st Century should, as appropriate, further analyze any errors identified in the Discovery SamplesSample. ▇▇▇▇▇▇▇▇ 21st Century recognizes that OIG or other HHS component, in its discretion and as authorized by statute, regulation, or other appropriate authority may also analyze or review Paid Claims included, or errors identified, in the Discovery Samples or any other segment of the universe.)