Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120, 421.122 and 421.201

Forms and Documents

Document Name	Status
Form CMS-10097 The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097) Form and Instruction	Modified
CMS-10097.Instructions for Contractor Letter-CLEAN-11-10-09.doc Supplementary Document	2009-11-10
CMS-10097.CMS Letter 2010 MCPSS - Thank you (#3)-CLEAN-11-10-09.doc Supplementary Document	2009-11-10
CMS-10097.CMS Letter 2010 MCPSS - survey invitation (#2)-CLEAN-11-10-09.doc Supplementary Document	2009-11-10
CMS-10097.CMS Letter 2010 MCPSS - survey invitation (#1)-CLEAN-11-10-09.doc Supplementary Document	2009-11-10
CMS-10097.CMS Response to OMB Review.doc Supplementary Document	2009-11-10
CMS-10097.Supp Stmt Part B - Collection of Information-CLEAN-11-10-09.doc Supporting Statement B	2009-11-10
SUMMARY OF INSTRUMENT REVISIONS.doc Supplementary Document	2009-09-11
Crosswalk.doc Supplementary Document	2009-09-11
Table of Contents.doc Supplementary Document	2009-09-11
At the conclusion of the first 60.docx Supplementary Document	2009-09-11
CMS-10097.Supp Stmt Part A- Background and Justification - CLEAN-11-10-09.doc Supporting Statement A	2009-11-10

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: 200909-0938-004
Status: Historical Active	Previous ICR Reference No: 200807-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Contractor Provider Satisfaction Survey (MCPSS) and Supporting Regulations in 42 CFR 421.120, 421.122 and 421.201
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: 11/13/2009
	Date Received in OIRA: 09/15/2009
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	12/31/2011
Responses	25,000	0	24,279
Time Burden (Hours)	9,349	0	8,346
Cost Burden (Dollars)	0	0	0

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Abstract: Each year, CMS obtains completed surveys from Medicare providers and suppliers via a survey about satisfaction, attitudes, and perceptions regarding the services provided by Medicare Fee-for-Service (FFS) Carriers, Fiscal Intermediaries, Regional Home Health Intermediaries, and Medicare Administrative Contractors. The survey focuses on basic business functions provided by the Medicare contractors, including Provider Inquiries, Provider Outreach and Education, Claims Processing, Appeals, Provider Enrollment, Medical Review, and Audit and Reimbursement. CMS uses the survey to monitor its contractors and to provide incentives for improved performance.The survey is conducted yearly and annual reports of the survey results are made available via a secure 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:
	74 FR 31738	07/02/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 46774	09/11/2009
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
The Annual Medicare Contractor Provider Satisfaction Survey (MCPSS): (CMS-10097)	CMS-10097	Medicare Contractor Provider Satisfaction Survey 2010

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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	25,000	24,279	0	721	0	0
Annual Time Burden (Hours)	9,349	8,346	0	1,003	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 increase in burden is due to small changes in the survey instrument.

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Annual Cost to Federal Government: $178,000,000

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)? No

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: 09/15/2009

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