The Medicare
Carrier Provider/Supplier Enrollment Application is approved for
use through 4/97 under the following conditions: 1) During the next
year, HCFA continues to use the AMA database for validation
purposes as it did for HCFA's UPIN files. In the next submission
for OMB review, HCFA evaluates the validity of provider/supplier
responses in the application and the cost effectiveness of
continued use of the AMA file for validation purposes; 2) HCFA
designs a second enrollment application form that would collect
race on a voluntary basis. This application should be used for a
representative random sample of new and existing Medicare
providers/suppliers. HCFA should evaluate the validity of self
reported race data by comparing application responses to the AMA
database; 3) HCFA makes responses to Question 4 on Professional
School Information and Question 2 on Provider/Supplier Specialty
voluntary. In addition, HCFA shall add a voluntary question on
board certification. OMB believes that these questions should be
voluntary because it is unclear how they relate to enumeration and
fundamental physician identification. In the next submission for
OMB review, HCFA should reevaluate the practical utility of these
data elements for HCFA and other Federal agencies such as DOL; 4)
In the next submission for OMB review, HCFA further should evaluate
whether the burden imposed by requirements for copies of certified
physician qualifications and billing agency contracts exceeds
benefits to the Federal government and beneficiaries/ recipients in
reduced fraud and abuse; 5) HCFA amends the section pertaining to
Independent Physiological Laboratories so that it is consistent
with regulations at 42 CFR 440.30. In particular, as agreed in its
response to public comments, HCFA shall amend the forms to clarify
that physician supervision is not mandatory. In addition, unless
HCFA can present compelling arguments supporting the regulatory and
analytic basis for questions per- taining to CPT codes, these
questions should be deleted; 6) Reverification procedures or
additional revisions to the enrollment application forms must be
submitted for PRA approval; 7) prior to fielding this form, HCFA
submits its Privacy Act statements and privacy assurances for
proprietary materials for OMB review and approval; 8) HCFA monitors
the application's questions pertaining to financial interest and
ownership and reevaluates the practical utility of these questions
in the next submission for OMB review; 9) pursuant to public
comment, no later than 5/96 HCFA amends its burden estimate for
this enrollment application; and 10) HCFA incorporates the
disclosure statements mandated by the Paperwork Reduction Act of
1995 and the implementing regulations at 5 CFR 1320 into the
forms/instructions.
Inventory as of this Action
Requested
Previously Approved
05/31/1997
05/31/1997
160,000
0
0
240,000
0
0
0
0
0
This information is needed to enroll
providers/suppliers by identifying them, verifying their
qualifications and eligibility to participate in Medicare, and to
price and pay their claims correctly.
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.
Medicare Carrier Provider/Supplier Enrollment Application