Medicare Program: Complex Medical Review

ICR 200508-0938-006

OMB: 0938-0969

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
8829 Migrated
ICR Details
0938-0969 200508-0938-006
Historical Active
HHS/CMS
Medicare Program: Complex Medical Review
New collection (Request for a new OMB Control Number)   No
Emergency 09/26/2005
Approved with change 09/15/2005
Retrieve Notice of Action (NOA) 08/19/2005
  Inventory as of this Action Requested Previously Approved
02/28/2006 02/28/2006
2,900,000 0 0
483,333 0 0
0 0 0

Medicare contractors conduct complex medical review to determine whether items or services billed are covered, correctly coded, and are reasonable and necessary for the condition of the patient. Under complex medical review the provider or supplier must submit a copy of the medical records.

None
None


No

1
IC Title Form No. Form Name
Medicare Program: Complex Medical Review CMS-10168

  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 2,900,000 0 0 2,900,000 0 0
Annual Time Burden (Hours) 483,333 0 0 483,333 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.
08/19/2005


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