Approved for use through 5/94 under the following conditions: Prior to full implementation: 1) HCFA amends the standard instructions for the HCFA 700 and 701 to include a brief description of each Form's purpose and mandated frequency; 2) HCFA amends the instructions and/or the optional Form 702 so that the content and numbering of both are consistent. Also, the more detailed version of instructions appears most useful and should be adopted for broad dissemination and should incorporate the burden disclosure statement; 3) HCFA should brief OMB staff on its plan for expanding use of the standard Forms to all Medicare contractors and providers. The briefin should include: 1) an explanation of HCFA's efforts to ensure that contractors and providers have adequate phase-in time and training for use of the new Forms; and 2) assurances that cost effective technologi used by providers are not restricted by the Forms' implementation. In its briefing, HCFA should present written materials describing the above issues and copies of the revised instructions referenced earlier In the next submission for OMB review, HCFA should include: 1) an update on its development of electronic formats; 2) a more detailed break down on the burden imposed by the standard (continued on separate page)
Inventory as of this Action
Requested
Previously Approved
05/31/1994
05/31/1994
10/31/1992
2,100,000
0
450,000
2,437,415
0
112,500
0
0
0
MEDICARE CONTRACTORS REQUIRE CERTAIN MEDICAL INFORMATION TO DETERMINE THAT REQUIREMENTS FOR MEDICARE COVERAGE ARE MET. THE INFORMATION IS USED TO DETERMINE IF BILLED SERVICES ARE PAYABLE IN ACCORDANCE WITH MEDICARE LAW, REGULATIONS, AND GUIDELINES. THE SERVICES IN QUESTION M BE PROVIDED BY HOSPITALS, SNFS, CORFS, RHC, HOSPICES ESRD FACILITIES, AND CHRISTIAN SCIENCE HOSPITALS AND SNFS.
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.
REQUEST FOR MEDICAL REVIEW OF PART B INTERMEDIARY OUTPATIENT THERAPY CLAIMS