Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52

Forms and Documents

Document Name	Status
CMS-R-50.Supporting Statement Part A.doc Supporting Statement A	2008-04-02

IC Document Collections

IC ID	Document Title	Status
8000	Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52	Modified

ICR Details

OMB Control No: 0938-0359	ICR Reference No: 200805-0938-001
Status: Historical Active	Previous ICR Reference No: 200502-0938-003
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/12/2008
	Date Received in OIRA: 05/02/2008
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved
Responses	276,500	0	0
Time Burden (Hours)	8,280	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Social Security Amendments of 1983 (Public Law 98-21), requires quality improvement organization (QIO) review of medical services provided to Medicare beneficiaries. Review of services under the QIO program can be accomplished by individual case review and the Clinical Data Abstraction Centers (CDACs). Accordingly, QIOs must review, at the direction of CMS: 1) all anti-dumping referrals; 2) beneficiary complaints involving quality issues; 3) potential gross and flagrant violations of unnecessary admission concerns identified during project data collection; 4) requests from hospitals for higher-weighted DRG adjustments; 5) hospital and managed care plan issued notices of non-coverage; 6) specific codes for assistants at cataract surgery; and 7) cases referred by CMS, the Office of the Inspector General, the Department of Justice, the managed care appeals contractor, intermediaries, carriers, or the CDACs.

---

Authorizing Statute(s): PL: Pub.L. 98 - 21 601-602 Name of Law: Social Security Amendments of 1983
   PL: Pub.L. 106 - 554 301 Name of Law: Benefits Improvement and Protection Act of 2000
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 6185	02/01/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 17984	04/02/2008
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medical Records Review Under PPS and Supporting Regulations at 42 CFR 412.40-412.52

---

ICR Summary of Burden

	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	276,500	0	0	-121,000	0	397,500
Annual Time Burden (Hours)	8,280	0	0	-3,645	0	11,925
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The number of medical records has decreased slightly. Expiration of some types of payment review, such as HPMP, and changes in the focus of the QIO Program have resulted in a decrease in the number of QIO reviews from 189,000 to 116,000. The CDAC reviews have been reduced to 160,000, from an average of 208,000 records reviewed annually. However, there is a small increase in cost due to more accurate page counts and increased postage. This results in a net increase of $466,000 (9.4 %) per year over the prior request.

---

Annual Cost to Federal Government: $7,676

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 05/02/2008

---