Approved for use
through 5/94 under the following conditions: Prior to full
implementation: 1) HCFA amends the standard instructions for the
HCFA 700 and 701 to include a brief description of each Form's
purpose and mandated frequency; 2) HCFA amends the instructions
and/or the optional Form 702 so that the content and numbering of
both are consistent. Also, the more detailed version of
instructions appears most useful and should be adopted for broad
dissemination and should incorporate the burden disclosure
statement; 3) HCFA should brief OMB staff on its plan for expanding
use of the standard Forms to all Medicare contractors and
providers. The briefin should include: 1) an explanation of HCFA's
efforts to ensure that contractors and providers have adequate
phase-in time and training for use of the new Forms; and 2)
assurances that cost effective technologi used by providers are not
restricted by the Forms' implementation. In its briefing, HCFA
should present written materials describing the above issues and
copies of the revised instructions referenced earlier In the next
submission for OMB review, HCFA should include: 1) an update on its
development of electronic formats; 2) a more detailed break down on
the burden imposed by the standard (continued on separate
page)
Inventory as of this Action
Requested
Previously Approved
05/31/1994
05/31/1994
10/31/1992
2,100,000
0
450,000
2,437,415
0
112,500
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 MEDICARE LAW, REGULATIONS,
AND GUIDELINES. THE SERVICES IN QUESTION M BE PROVIDED BY
HOSPITALS, SNFS, CORFS, RHC, HOSPICES ESRD FACILITIES, AND
CHRISTIAN SCIENCE HOSPITALS AND SNFS.
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.
REQUEST FOR MEDICAL REVIEW OF PART B INTERMEDIARY OUTPATIENT THERAPY CLAIMS