CMS is requesting PRA approval to collect medical records for 2 demonstrations in order to ensure proper payment of claims. The information required under this collection is requested by Medicare contractors to determine proper payment or if there is a suspicion of fraud. Medicare contractors may request the information from providers or suppliers submitting claims for payment from the Medicare program when data analysis indicates aberrant billing patterns or other information which may present a vulnerability to the Medicare program. For items with a history of aberrant billing patterns this information is requested in advance to determine appropriate payment or if there is a suspicion of fraud.
US Code:
42 USC 1395ddd
Name of Law: Medicare Integrity Program
US Code:
42 USC 1395y
Name of Law: EXCLUSIONS FROM COVERAGE AND MEDICARE AS SECONDARY PAYER
US Code:
42 USC 1395g
Name of Law: Payment to providers of services
The Recovery Auditor Contractor (RAC) pre-pay review demonstration has ended. Therefore, the burden hours have decreased by 75,000 hours (from 165,688 hours to 90,688 hours).
This ICR focuses on a continuation of a 3-year demonstration project. All collections will follow current documentation requirements. Medicare has long had the authority to request and collect medical information to support the medical necessity of services rendered. We are estimating the burden will be 30 minutes per case, which is consistent with previous estimates for the amount of time to complete pre-payment medical review. This has not changed from our prior supporting statement.
$25,500,000
No
No
No
No
No
No
Uncollected
Jamaa Hill 301 492-4190
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.
CMS-10421 - Supporting Statement 30day.docx
Signature Attestation