Common use of Quantitative Results Clause in Contracts

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies ▇▇▇▇▇▇ Valley differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇ Valley. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇ Valley. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇ Valley. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items or services where a waiver of a cost-sharing amount was not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companiesappropriate. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted drawdowns by the U.S. Healthcare Supply DMEPOS Companies BPMC from PMS differed from what should have been the correct coding drawn down from PMS and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. ii. Total number and percentage of instances in which the IRO determined that a Paid Specified Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. iii. Total number and percentage of instances in which the IRO determined that a Paid Specified Claim was for items or services that were not medically necessary based upon unallowable costs and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesBPMC. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Drawdown Review Sample. v. Total dollar amount of Paid Specified Claims included in the Drawdown Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Drawdown Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Drawdown Review Sample by the total dollar amount associated with the Paid Specified Claims in the Claims Drawdown Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixvii. A spreadsheet of the Claims Drawdown Review results that includes the following information for each Paid Specified Claim: Federal health care program award billed, beneficiary health insurance claim number, date of servicedrawdown, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO)drawn down through PMS, correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount, and reason for any difference between the amount drawn down through PMS and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies NAHC differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesNAHC. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesNAHC. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesNAHC. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesNAHC. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Saber differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSaber. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSaber. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSaber. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSaber. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies FHS differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesFHS. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesFHS. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesFHS. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesFHS. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOverpayment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately 52 documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOverpayment. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOverpayment. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. v. Total dollar amount of Paid Claims included in the Claims Review Sample. viivi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixviii. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Longwood differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLongwood. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLongwood. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLongwood. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLongwood. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies in any Claims Review Sample differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesVibra. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim in any Claims Review Sample was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesVibra. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim in any Claims Review Sample was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesVibra. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments identified in the each Claims Review Sample. vi. v. Total dollar amount of Paid Claims included in the each Claims Review Sample. viivi. Error Rate in the Claims Review Sample. The For each Claims Review Sample, the Error Rate shall be calculated by dividing the Overpayment the total dollar amount of all Overpayments identified in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the respective Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixviii. A spreadsheet of the Claims Review results that includes the following information for each Paid ClaimClaim in each Claims Review Sample: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies ▇▇▇▇▇▇▇ differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇▇. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇▇. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇▇. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. v. Total dollar amount of Paid Claims included in the Claims Review Sample. viivi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. Total number and percentage of instances in which the IRO determined that copayments and other cost-sharing amounts were not collected or waived in accordance with applicable payor requirements and the total amount of such copayments or cost-sharing amounts. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, copayment or other cost sharing amount collected, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Signature differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSignature. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSignature. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSignature. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesSignature. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample, if any. vi. Total dollar amount of Paid Claims included in the Claims Review Sample, if any. vii. Error Rate in the Claims Review Sample, if any. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies LCCA differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLCCA. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLCCA. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLCCA. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesLCCA. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies APM, Park Center, or ▇▇▇▇▇▇ differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesAPM, Park Center, and ▇▇▇▇▇▇. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesAPM, Park Center, and ▇▇▇▇▇▇. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesAPM, Park Center, and ▇▇▇▇▇▇. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample.Sample.‌ vi. v. Total dollar amount of Paid Claims included in the Claims Review Sample.Sample.‌ viivi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixviii. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.amount.‌

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies OC or ▇▇▇▇▇▇ differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOC or ▇▇▇▇▇▇. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOC or ▇▇▇▇▇▇. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesOC or ▇▇▇▇▇▇. iv. Total number and percentage of Any instances in which the IRO determined that dosage amount(s) of administered pharmaceuticals billed on a Paid Claim did not comply is inconsistent with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companiesavailable inventory for such pharmaceutical. v. Total dollar amount of all Overpayments in the Quarterly Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Quarterly Claims Review Sample. vii. Error Rate in the Quarterly Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Quarterly Claims Review Sample by the total dollar amount associated with the Paid Claims in the Quarterly Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted (e.g.submitted, DRG, CPT code, etc.), procedure code reimbursed, allowed amount reimbursed by payor, correct procedure code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Essex differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesEssex. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesEssex. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesEssex. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesEssex. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Diversicare differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesDiversicare. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesDiversicare. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesDiversicare. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did was for items and services that were not comply with appropriate and sufficient to meet the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless needs of whether it a patient in the assigned Case Mix Groups and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesDiversicare. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.submitted

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies ▇▇▇▇▇▇ differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies▇▇▇▇▇▇. iii. Total number and percentage dollar amount of instances all Overpayments in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesClaims Review Sample. iv. Total number and percentage dollar amount of instances all Overpayments in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companieseach Population. v. Total dollar amount of all Overpayments Paid Claims included in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sampleeach Population. vii. Error Rate The error rate in the Claims Review Sample. The Error Rate error rate in the Claims Review Sample shall be calculated by dividing the Overpayment total dollar amount of all Overpayments in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. The error rate in each Population. The error rate in each Population shall be calculated by dividing total dollar amount of Paid Claims in each Population by the total dollar amount associated with the Paid Claims in each Population. ix. An estimate of the actual Overpayment in the each Population at the mean point estimate. ix. x. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, location of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies Provider (Submitted Claim) differed from what should have been the correct coding claim (Correct Claim) and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesProvider. ii. Total number and percentage of instances in which the IRO determined that Provider did not maintain adequate documentation of a prescription drug (or refill) for which a Paid Claim was not appropriately documented submitted and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesProvider. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS CompaniesProvider. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Quarterly Claims Review Sample. vi. v. Total dollar amount of Paid Claims included in the Quarterly Claims Review Sample. viivi. Error Rate in the Quarterly Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Quarterly Claims Review Sample by the total dollar amount associated with the Paid Claims in the Quarterly Claims Review Sample. viiivii. An estimate of the actual Overpayment in the Population at the mean point estimate. ixviii. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, national drug code submitted (e.g.submitted, DRGquantity prescribed, CPT codequantity dispensed, etc.)quantity billed, code reimbursed, allowed amount reimbursed by payor, correct code amount reimbursed (as determined by the IRO), correct allowed amount (as determined by the IRO), and any dollar difference between allowed amount reimbursed by payor and the correct allowed amountamount reimbursed (as determined by the IRO).