Extension of
UB-92 approved for use through 12/2002 under the condition that the
next submission for OMB review: 1) reflects implementation of HIPAA
and the burden estimate is adjusted accordingly. In addition, no
later than 8/2002, CMS must submit to OMB a correction worksheet
reflecting the requested burden reduction and a detailed
explanation of the data and assumptions behind this new estimate;
2) includes a description of the CMS work group's progress in
resolving emergency room billing issues. Resolution of these issues
may necessitate changes to the collection/use of type of admission
and admission diagnosis codes on the UB-92. (OMB also references
this condition in its recent clearance of the Medicare ABN, OMB #
0938-0566); and 3) includes a current copy of the UB-92, the
supporting manual instructions, and the National Standard Format
(electronic format).
Inventory as of this Action
Requested
Previously Approved
12/31/2002
12/31/2002
07/31/2002
158,603,290
0
147,343,290
1,960,991
0
1,960,991
0
0
0
This standardized form is used in the
Medicare/Medicaid program to applly for reimbursement of covered
services by all providers that accept Medicare/Medicaid assigned
claims.
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 Uniform Institutional Provider Bill and Supporting Regulatins in 42 CFR 424.5