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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0938-1169
ICR Reference No:
201802-0938-005
Status:
Historical Inactive
Previous ICR Reference No:
201412-0938-011
Agency/Subagency:
HHS/CMS
Agency Tracking No:
21057
Title:
Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration (CMS-10421)
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Withdrawn
Conclusion Date:
05/24/2018
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/07/2018
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
36 Months From Approved
01/31/2018
Responses
0
0
150,000
Time Burden (Hours)
0
0
75,000
Cost Burden (Dollars)
0
0
0
Abstract:
CMS is requesting PRA approval to collect medical records for 2 demonstrations in order to ensure proper payment of claims. The information required under this collection is requested by Medicare contractors to determine proper payment or if there is a suspicion of fraud. Medicare contractors may request the information from providers or suppliers submitting claims for payment from the Medicare program when data analysis indicates aberrant billing patterns or other information which may present a vulnerability to the Medicare program. For items with a history of aberrant billing patterns this information is requested in advance to determine appropriate payment or if there is a suspicion of fraud.
Authorizing Statute(s):
US Code:
42 USC 1395ddd
Name of Law: Medicare Integrity Program
US Code:
42 USC 1395y
Name of Law: EXCLUSIONS FROM COVERAGE AND MEDICARE AS SECONDARY PAYER
US Code:
42 USC 1395g
Name of Law: Payment to providers of services
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
82 FR 52304
11/13/2017
30-day Notice:
Federal Register Citation:
Citation Date:
83 FR 5426
02/07/2018
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
2
IC Title
Form No.
Form Name
PMD Demonstration
Recovery Auditor Pre-payment review Demonstration
Signature Attestation
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
The Recovery Auditor Contractor (RAC) pre-pay review demonstration has ended. Therefore, the burden hours have decreased by 75,000 hours (from 165,688 hours to 90,688 hours). This ICR focuses on a continuation of a 3-year demonstration project. All collections will follow current documentation requirements. Medicare has long had the authority to request and collect medical information to support the medical necessity of services rendered. We are estimating the burden will be 30 minutes per case, which is consistent with previous estimates for the amount of time to complete pre-payment medical review. This has not changed from our prior supporting statement.
Annual Cost to Federal Government:
$25,500,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Jamaa Hill 301 492-4190
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
02/07/2018
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