Other Requirements. a. Supplemental Materials. The IRO shall request all
documentation and documentationand materials required for its review of
the each Paid Claims
in associatedwith each Patient Stay selected as part of the Claims Review
Sample and Progenity Sampleand Diversicare shall furnish such documentation and materials
foreach Paid Claim associated with each Patient Stay selected as part ofthe Claims Review Sample to the IRO prior to the IRO initiating
its review itsreview of
a specific Patient Stay in... the Claims Review Sample. If the Ifthe IRO accepts any Progenity, Inc. CIA Appendix C 1 supplemental documentation or materials from Progenity fromDiversicare after the IRO has completed its initial review of a PatientStay selected as part of the Claims Review Sample (Supplemental Materials), Samples (SupplementalMaterials), the IRO shall identify in the Claims Review Report the Supplemental theSupplemental Materials, the date the Supplemental Materials were accepted, wereaccepted, and the relative weight the IRO gave to the Supplemental Materials SupplementalMaterials in its review. In addition, the IRO shall include a narrative in narrativein the Claims Review Report describing the process by which the Supplemental theSupplemental Materials were accepted and the IRO's reasons for accepting foraccepting the Supplemental Materials. b. Paid Claims without Supporting Documentation. Any Paid Claim for Claimfor which Progenity Diversicare cannot produce documentation shall be considered beconsidered an error and the total reimbursement received by Progenity byDiversicare for such Paid Claim shall be deemed an Overpayment. Replacement Overpayment.Replacement sampling for Paid Claims with missing documentation is documentationis not permitted. c. Use of First Samples Drawn. For the purposes of the Claims Review Sample ReviewSample discussed in this Appendix, the first set of Paid Claims selected Patient Staysselected for the Subject Facility shall be used (i.e., it is not permissible notpermissible to generate more than one list of random samples and then andthen select one for use with the a Claims Review Sample).
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Other Requirements. a. Supplemental Materials. The IRO shall request all documentation and materials required for its review of the Paid Claims in the Claims Review Sample and
Progenity UHS or the Subject Facility shall furnish such documentation and materials to the IRO prior to the IRO initiating its review of the Claims Review Sample. If the IRO accepts any
Progenity, Inc. CIA Appendix C 1 supplemental documentation or materials from
Progenity UHS or the Subject Facility after the IRO has completed its initial
... review of the Claims Review Sample (Supplemental Materials), the IRO shall identify in the Claims Review Report the Supplemental Materials, the date the Supplemental Materials were accepted, and the relative weight the IRO gave to the Supplemental Materials in its review. In addition, the IRO shall include a narrative in the Claims Review Report describing the process by which the Supplemental Materials were accepted and the IRO's reasons for accepting the Supplemental Materials. b. Paid Claims without Supporting Documentation. Any Paid Claim for which Progenity the Subject Facility or Facilities cannot produce Universal Health Services, Inc. CIA - Appendix B 50 documentation shall be considered an error and the total reimbursement received by Progenity the Subject Facility or Facilities for such Paid Claim shall be deemed an Overpayment. Replacement sampling for Paid Claims with missing documentation is not permitted. c. Use of First Samples Drawn. For the purposes of the Claims Review Sample discussed in this Appendix, the first set of Paid Claims selected shall be used (i.e., it is not permissible to generate more than one list of random samples and then select one for use with the Claims Review Sample).
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Other Requirements. a. Supplemental Materials. The IRO shall request all documentation and materials required for its review of the Paid Claims
in selected as part of the
Claims Review Discovery Sample
or Full Sample (if applicable), and
Progenity Amedisys shall furnish such documentation and materials to the IRO prior to the IRO initiating its review of the
Claims Review Sample. Discovery Sample or Full Sample (if applicable). If the IRO accepts any
Progenity, Inc. CIA Appendix C 1 supplemental documentation or
... materials from Progenity Amedisys after the IRO has completed its initial review of the Claims Review Discovery Sample or Full Sample (if applicable) (Supplemental Materials), the IRO shall identify in the Claims Review Report the Supplemental Materials, the date the Supplemental Materials were accepted, and the relative weight the IRO gave to the Supplemental Materials in its review. In addition, the IRO shall include a narrative in the Claims Review Report describing the process by which the Supplemental Materials were accepted and the IRO's reasons for accepting the Supplemental Materials. b. Paid Claims without Supporting Documentation. Any Paid Claim for which Progenity Amedisys cannot produce any documentation to support the Paid Claim shall be considered an error and the total reimbursement received by Progenity Amedisys for such Paid Claim shall be deemed an Overpayment. Replacement sampling for Paid Claims with missing documentation is not permitted. c. Use of First Samples Drawn. For the purposes of the Claims Review Sample all samples (Discovery Sample(s) and Full Sample(s)) discussed in this Appendix, the first set of Paid Claims selected in each first sample shall be used (i.e., it is not permissible to generate more than one list of random samples and then select one for use with the Discovery Sample or Full Sample). Amedisys, Inc. and Amedisys Holding, LLC Corporate Integrity Agreement Appendix B 6. Repayment of Identified Overpayments. Amedisys shall repay within 30 days any Overpayment(s) identified in the Discovery Sample, regardless of the Error Rate, and (if applicable) the Full Sample, including the IRO's estimate of the actual Overpayment in the Population as determined in accordance with Section A.3 above, in accordance with payor refund policies. Amedisys shall make available to OIG all documentation that reflects the refund of the Overpayment(s) to the payor. B. Claims Review Sample). Report. The IRO shall prepare a Claims Review Report as described in this Appendix for each Claims Review performed. The following information shall be included in the Claims Review Report for each Discovery Sample and Full Sample (if applicable).
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