MEDICARE: SUPPORTING STATEMENT FOR REQUEST FOR MEDICAL REVIEW INFORMATION FOR PART B OUTPATIENT BILLS

ICR 198906-0938-009

OMB: 0938-0549

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
0938-0549 198906-0938-009
Historical Active
HHS/CMS
MEDICARE: SUPPORTING STATEMENT FOR REQUEST FOR MEDICAL REVIEW INFORMATION FOR PART B OUTPATIENT BILLS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/19/1989
Retrieve Notice of Action (NOA) 06/21/1989
Approved for use through 10/90 under the condition that HCFA incorporates these information collection requirements into the next submission for "Supporting Statement for Request for Medical Review Information for Part B Intermediary Outpatient Therapy Bills" (OMB No. 0938-0227, expiration date 10/90).
  Inventory as of this Action Requested Previously Approved
10/31/1990 10/31/1990
4,649,831 0 0
2,324,915 0 0
0 0 0

MEDICARE CONTRACTORS REQUIRE CERTAIN MEDICAL INFORMATION TO DETERMINE THAT REQUIREMENTS FOR MEDICARE COVERAGE ARE MET. THE INFORMATION IS USED TO DETERMINE IF BILLED SERVICES ARE PAYABLE IN ACCORDANCE WITH MEDICAL LAW, REGULATIONS AND GUIDELINES. THE SERVICES IN QUESTION MAY BE PROVIDED BY HOSPITALS, SNFS, CORFS, RUC, HOSPICES, ESRD FACILITIES AND CHRISTIAN SCIENCE HOSPITALS AND SNFS.

None
None


No

1
IC Title Form No. Form Name
MEDICARE: SUPPORTING STATEMENT FOR REQUEST FOR MEDICAL REVIEW INFORMATION FOR PART B OUTPATIENT BILLS HCFA-9027

  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 4,649,831 0 0 4,649,831 0 0
Annual Time Burden (Hours) 2,324,915 0 0 2,324,915 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/21/1989


© 2024 OMB.report | Privacy Policy