View Information Collection Request (ICR) Package
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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:
0938-0969
ICR Reference No:
200608-0938-003
Status:
Historical Active
Previous ICR Reference No:
200508-0938-006
Agency/Subagency:
HHS/CMS
Agency Tracking No:
Title:
Medicare Program: Complex Medical Review
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
01/05/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/29/2006
Terms of Clearance:
The burden increase associated with the approved collection reflects an increase in the projected time a provider or supplier will need to submit a copy of the medical records to indicate the items or services billed are reasonable and necessary for the condition of the patient. Upon resubmission, CMS will solicit comment on the burden associated with this requirement and will make any necessary modifications to the burden calculation.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2010
36 Months From Approved
01/31/2007
Responses
2,900,000
0
2,900,000
Time Burden (Hours)
966,667
0
483,333
Cost Burden (Dollars)
0
0
0
Abstract:
Medicare contractors conduct complex medical review to determine whether items or services billed are covered, correctly coded, and are reasonable and necessary for the condition of the patient. Under complex medical review the provider or supplier must submit a copy of the medical records.
Authorizing Statute(s):
US Code:
42 USC 1395l
Name of Law: Payment of Benefits
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
PL:
Pub.L. 108 - 173 934
Name of Law: Prepayment Review
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:
71 FR 33460
06/06/2006
30-day Notice:
Federal Register Citation:
Citation Date:
71 FR 50427
08/25/2006
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Medicare Program: Complex Medical Review
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
2,900,000
2,900,000
0
-24,208
24,208
0
Annual Time Burden (Hours)
966,667
483,333
0
1,678
481,656
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Medicare has long had the authority to request and collect medical information to support the medical necessity of services rendered. This collection does not represent a change in policy. We increased our estimate to 20 minutes due to comments on the CMS-6022-P regulation.
Annual Cost to Federal Government:
$20,000,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Dan Schwartz 410 786-4197
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:
08/29/2006
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