CMS-10763.Final_MR_TPE_fast-track-PRA

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0938-1185)

TITLE OF INFORMATION COLLECTION: Medicare Administrative Contactors Customer Experience – Medical Review

PURPOSE:

As established in Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003, CMS relies on a network of private health care insurers known as Medicare Administrative Contractors (MACs) to perform a variety of services. MACs also serve as the primary operational contact between the Medicare Fee-for-Service program and the health care providers enrolled in the program.  There are currently sixteen multi-state MAC jurisdictions (represented by the following letters and numbers—J5, J6, J8, J15, JA, JB, JC, JD, JE, JF, JH, JL, JK, JL, JM and JN) responsible for processing Medicare Part A, Part B and Durable Medical Equipment (DME) claims and performing many activities including:

• Enrolling providers in the Medicare FFS program

• Handling appeals requests

• Responding to provider inquiries

• Educating providers about Medicare FFS billing requirements

• Performing Medical Review

MMA Section 911 also requires CMS to include provider satisfaction as a MAC performance measurement. This requirement builds on Executive Order 12862, which requires Federal Agencies to continuously reform practices and operations to improve the customer experience by surveying customers to determine the kind and quality of services they want and their level of satisfaction with existing services. Based on the two, CMS developed the MAC Customer Experience (MCE) program.

The MCE consists of multiple satisfaction surveys deployed using a variety of media (e.g., website pop-up, link, etc.) to gauge satisfaction with MAC services. The goal of this effort is to reduce survey fatigue, collect actionable data to help improve the customer experience and increase the response rate from prior feedback efforts. CMS plans to use a series of short targeted surveys in both English and Spanish to obtain feedback through various touch points providers use to interact with their MAC. The MCE allows CMS a “global” perspective of providers’ experiences and their overall satisfaction with the MAC, while also allowing CMS to capture satisfaction with specific MAC functional areas like claims processing, enrollment and appeals.

This fast track request is one in a series of requests submitted over time as part of the overall MCE program. Specifically, this requests intends to collect feedback from Medicare providers about their experience with the MACs’ Medical Review Targeted Probe and Educate (TPE) process.

DESCRIPTION OF RESPONDENTS:

Respondents to these surveys include, but are not limited to Medicare providers, suppliers, or their employees who interact with the MACs’ Medical Review staff.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name: Amy Abel-Matkins________________________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ x ] Yes [ ] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ x ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ x ] Yes [ ] No

09-90-1901 HHS Correspondence, Customer Service, and Contact List Records
SORN history: 84 FR 28823 (6/20/19)

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ x ] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Medicare Providers, Medicare Suppliers, Provider/Supplier Billing Staff	3,000	3 minutes	150 hours
Totals	3,000	3 minutes	150 hours

FEDERAL COST: The estimated annual cost to the Federal government is $36,322.69 ____________

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [x ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The goal of the CMS Medical Review program is to reduce payment error by identifying and addressing billing errors concerning coverage and coding made by providers. MACs proactively identify patterns of potential billing errors concerning Medicare coverage and coding made by providers through data analysis and evaluation of other information (e.g. complaints).

If a MAC discovers a pattern of high denial rates or unusual billing practices the provider is selected to participate in a TPE audit. The MAC reviews a sample of the provider’s submitted claims and determines the accuracy of the claims submitted. Throughout the audit, the MAC communicates with the provider through hardcopy letters e-mail or an electronic portal. CMS plans to include survey links on these hardcopy letters e-mails or electronic communications. CMS may also use the Medical Review section of the MACs’ websites to present a survey dealing with their Medical Review experience.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ x ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ X ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ x ] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

Instructions for completing Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback”

TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is the subject of the request. (e.g. Comment card for soliciting feedback on xxxx)

PURPOSE: Provide a brief description of the purpose of this collection and how it will be used. If this is part of a larger study or effort, please include this in your explanation.

DESCRIPTION OF RESPONDENTS: Provide a brief description of the targeted group or groups for this collection of information. These groups must have experience with the program.

TYPE OF COLLECTION: Check one box. If you are requesting approval of other instruments under the generic, you must complete a form for each instrument.

CERTIFICATION: Please read the certification carefully. If you incorrectly certify, the collection will be returned as improperly submitted or it will be disapproved.

Personally Identifiable Information: Provide answers to the questions. Note: Agencies should only collect PII to the extent necessary, and they should only retain PII for the period of time that is necessary to achieve a specific objective.

Gifts or Payments: If you answer yes to the question, please describe the incentive and provide a justification for the amount.

BURDEN HOURS:

Category of Respondents: Identify who you expect the respondents to be in terms of the following categories: (1) Individuals or Households; (2) Private Sector; (3) State, local, or tribal governments; or (4) Federal Government. Only one type of respondent can be selected per row.

No. of Respondents: Provide an estimate of the Number of Respondents.

Participation Time: Provide an estimate of the amount of time (in minutes) required for a respondent to participate (e.g. fill out a survey or participate in a focus group)

Burden: Provide the Annual burden hours: Multiply the Number of Respondents and the Participation Time then divide by 60.

FEDERAL COST: Provide an estimate of the annual cost to the Federal government.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents. Please provide a description of how you plan to identify your potential group of respondents and how you will select them. If the answer is yes, to the first question, you may provide the sampling plan in an attachment.

Administration of the Instrument: Identify how the information will be collected. More than one box may be checked. Indicate whether there will be interviewers (e.g. for surveys) or facilitators (e.g., for focus groups) used.

Submit all instruments, instructions, and scripts are submitted with the request.

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