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For instance, if a demanded overpayment determination was for a payment amount on a claim with a HCPCS or CPT code identified as having significant, anomalous, and highly suspect billing activity, and therefore the payment amount was excluded from certain financial calculations used in determining the ACO's financial performance under the proposed adjustment discussed in section III.G.7.d of the CY 2025 PFS proposed rule, we would not include this amount as part of a reopening for the same performance year

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Health Conditions : Certain medical histories may favor one form over another

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