Medicare Program: Complex Medical Review

Forms and Documents

Document Name	Status
CMS-10168[1].Supporting Statement.5-19-06.doc Supporting Statement A	2006-08-28

IC Document Collections

IC ID	Document Title	Status
8829	Medicare Program: Complex Medical Review	Modified

ICR Details

OMB Control No: 0938-0969	ICR Reference No: 200608-0938-003
Status: Historical Active	Previous ICR Reference No: 200508-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Program: Complex Medical Review
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/05/2007
	Date Received in OIRA: 08/29/2006
Terms of Clearance: The burden increase associated with the approved collection reflects an increase in the projected time a provider or supplier will need to submit a copy of the medical records to indicate the items or services billed are reasonable and necessary for the condition of the patient. Upon resubmission, CMS will solicit comment on the burden associated with this requirement and will make any necessary modifications to the burden calculation.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	01/31/2007
Responses	2,900,000	0	2,900,000
Time Burden (Hours)	966,667	0	483,333
Cost Burden (Dollars)	0	0	0

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Abstract: Medicare contractors conduct complex medical review to determine whether items or services billed are covered, correctly coded, and are reasonable and necessary for the condition of the patient. Under complex medical review the provider or supplier must submit a copy of the medical records.

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Authorizing Statute(s): US Code: 42 USC 1395l Name of Law: Payment of Benefits
   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
   PL: Pub.L. 108 - 173 934 Name of Law: Prepayment Review
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 33460	06/06/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 50427	08/25/2006
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Medicare Program: Complex Medical Review

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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	2,900,000	2,900,000	0	-24,208	24,208	0
Annual Time Burden (Hours)	966,667	483,333	0	1,678	481,656	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Medicare has long had the authority to request and collect medical information to support the medical necessity of services rendered. This collection does not represent a change in policy. We increased our estimate to 20 minutes due to comments on the CMS-6022-P regulation.

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Annual Cost to Federal Government: $20,000,000

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

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Common Form ICR:  No

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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: 08/29/2006

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