MEDICARE -- INFORMATION ON PROVIDER REFUNDS

ICR 199207-0938-010

OMB: 0938-0383

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
113618 Migrated
ICR Details
0938-0383 199207-0938-010
Historical Active 198906-0938-020
HHS/CMS
MEDICARE -- INFORMATION ON PROVIDER REFUNDS
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 10/03/1992
Retrieve Notice of Action (NOA) 07/31/1992
Approved for use through 4/93 under the condition that the next submission includes Medicare contractor recovery policies revised by HCFA as appropriate. Such new policies should be consistent with OBRA '89 limitations on physician balanced billing and the new Explanation of Medicare Benefits effective January 1993.
  Inventory as of this Action Requested Previously Approved
04/30/1993 04/30/1993
3,851 0 0
963 0 0
0 0 0

WHEN A MEDICARE CLAIM IS DENIED AND THEN PAID AS A RESULT OF A RECONSIDERATION, THERE IS A POSSIBILITY THAT THE PROVIDER HAS ALREADY BEEN PAID BY THE BENEFICIARY. THESE QUESTIONS ON PROVIDER REFUNDS WIL BE USED ON INTERMEDIARY FORMS TO VERIFY THAT THE PROVIDER HAS REFUNDED THE BENEFICIARY'S MONEY.

None
None


No

1
IC Title Form No. Form Name
MEDICARE -- INFORMATION ON PROVIDER REFUNDS HCFA-9049

  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 3,851 0 0 3,851 0 0
Annual Time Burden (Hours) 963 0 0 963 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.
07/31/1992


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