The Independent Diagnostic Testing Facilities (IDTF) - Site Investigation form was developed and implemented to allow for CMS to have a standard format to collect and verify information regarding the compliance of independent diagnostic testing facilities (IDTFs) with the performance standards found in 42 CFR 410.33(g). CMS is now seeking re-instatement of the use of this form.
PL:
Pub.L. 105 - 33 4313
Name of Law: BBA of 1997
PL:
Pub.L. 104 - 134 31001
Name of Law: The Debt Collection Improvement Act of 1996
US Code:
42 USC 1395f
Name of Law: Requirement of Requests and Certifications
US Code:
42 USC 1395g
Name of Law: PAYMENT TO PROVIDERS OF SERVICES
US Code:
42 USC 1395l
Name of Law: Payment of Benefits
US Code:
42 USC 1395u
Name of Law: PROVISIONS RELATING TO THE ADMINISTRATION OF PART B
US Code:
42 USC 1395m
Name of Law: SPECIAL PAYMENT RULES FOR PARTICULAR ITEMS AND SERVICES
US Code:
42 USC 1395cc
Name of Law: AGREEMENTS WITH PROVIDERS OF SERVICES; ENROLLMENT PROCESSES
The last burden estimate was based on 2,700 respondents in a three year period with a three year total burden hours of 5,400. This was calculated at an hour amount per application (two hours per application). Based on these numbers, there is an annual decrease in respondents of 173 (from 900 to 727). CMS believes this decrease is due to less IDTFs entering the Medicare program. Similarly, there is an annual decrease in burden hours of 346 (from 1,800 hours to 1,454 hours). Over a three year period, the hour burden has decreased by 1,038 hours (from 5,400 to 4,362 hours).
$145,400
No
No
Yes
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.
Form CMS-10221 Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs)
CMS-10221 - Supporting Statement 30-day 2019 rev.docx
Worksheet for Recording Results of Medicare Site Visits of Independent Diagnostic Testing Facilities (IDTFs)