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 The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097) Form and Instruction	Modified
Responses to 120108 Inquiry from OMB final.doc Supplementary Document	2008-12-10
OMB Supporting Statement - Part B.docm Supporting Statement B	2008-07-23
Change Summary.pdf Supplementary Document	2008-07-23
ATTACHMENT 5 - DATA ANALYSIS.docm Supplementary Document	2008-07-23
ATTACHMENT 4 - EXAMPLE OF COG INTVW.docm Supplementary Document	2008-07-23
OMB Supporting Statement - Part A.docm Supporting Statement A	2008-07-23

IC Document Collections

IC ID	Document Title	Status
8757	The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0915	ICR Reference No: 200807-0938-005
Status: Historical Active	Previous ICR Reference No: 200705-0938-001
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 with change	Conclusion Date: 12/12/2008
	Date Received in OIRA: 07/30/2008
Terms of Clearance: This ICR is approved consistent with CMS memos of 12/3/08 and 12/9/08. Per the 12/3/08 memo, CMS agrees to print the OMB control number expiration date on all survey instruments. Per the 12/9/08 memo, CMS agrees to provide cell sizes and standard error information in the public reports, as CMS currently does for the contractor reports. This information will aid the public in interpreting the results.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	36 Months From Approved	08/31/2010
Responses	24,279	0	24,279
Time Burden (Hours)	8,346	0	8,346
Cost Burden (Dollars)	0	0	0

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Abstract: 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:
	73 FR 24293	05/02/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 42578	07/22/2008
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
The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097)	CMS-10097	MCPSS National Implementation 2009 Survey Instrument

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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	24,279	0	0	0	0
Annual Time Burden (Hours)	8,346	8,346	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,600,000

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: 07/30/2008

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