Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120 and 421.122

Forms and Documents

Document Name	Status
Form CMS-10097 Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120 and 421.122 Form and Instruction	Modified
CMS-10097.OMB Supporting Statement Part B.pdf Supporting Statement B	2007-05-01
CMS-10097.ATTACHMENT 3 - REDLINED SURVEY.pdf Supplementary Document	2007-05-01
CMS-10097.Responses to AMA comments.doc Supplementary Document	2007-05-01
CMS-10097.AMA Comments-4-24-07.doc Supplementary Document	2007-05-01
CMS-10097.Attachment 1 Sample Design.pdf Supplementary Document	2007-05-01
CMS-10097.OMB Supporting Statement Part A.pdf Supporting Statement A	2007-05-01

IC Document Collections

IC ID	Document Title	Status
8757	Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120 and 421.122 Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0915	ICR Reference No: 200705-0938-001
Status: Historical Active	Previous ICR Reference No: 200610-0938-006
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120 and 421.122
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/23/2007
	Date Received in OIRA: 05/08/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	01/31/2009	06/30/2009
Responses	24,279	0	20,514
Time Burden (Hours)	8,346	0	6,975
Cost Burden (Dollars)	0	0	0

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Abstract: The Centers for Medicare & Medicaid Services will obtain feedback from over 30,000 Medicare Providers via a survey about satisfaction, attitudes and perceptions regarding the services provided by Medicare Fee-for-Service (FFS) Carriers, Fiscal Intermediaries, Durable Medical Equipment Suppliers, and Regional Home Health Intermediaries and Medicare Administrative Contractors. The survey focuses on basic business functions provided by the Medicare Contractors such as Inquiries, Provider Communications, Claims Processing, Appeals, Provider Enrollment, Medical Review and Provider Audit & Reimbursement. Providers will receive a notice requesting they use a specially constructed Web site to respond to a set of questions customized for their Contractor's responsibilities. The survey will be conducted yearly and annual reports of the survey results will be available via an online reporting system for use by CMS, Medicare Contractors, and the general public.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 911(b)(3)(B) Name of Law: Medicare Prescription Drug, Improvement, and Modernization Act of 2003
  

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:
	72 FR 8167	02/23/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 21023	04/27/2007
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120 and 421.122	CMS-10097, CMS-10097	MCPSS Survey ,   CMS-10097.Sample Cognitive Interview Protocol

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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	24,279	20,514	0	3,765	0	0
Annual Time Burden (Hours)	8,346	6,975	0	1,371	0	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: The overall sample burden, including both prescreening and survey completion activities, has been increased from 6923 to 8286, an increase of 1,363 hours. The reason for this increase is so that CMS can obtain state-level estimates, and thus better monitor the work that Contractors are doing with the Medicare providers. We also estimate an additional 60 burden hours for research and development activities. The total annual increase in burden is 1,423 hours.

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Annual Cost to Federal Government: $1,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 05/08/2007

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