Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration

Forms and Documents

Document Name	Status
CMS-10421_Justification of Nonmaterial Change.docx Justification for No Material/Nonsubstantive Change	2013-12-03
CMS-10421.Revised Burden Tables.docx Supplementary Document	2013-12-03
CMS-10421.Revised Supporting Statement Part A.doc Supporting Statement A	2013-12-03

IC Document Collections

IC ID	Document Title	Status
202524	Signature Attestation	Modified
202523	PMD Demonstration	Modified
202522	Recovery Auditor Pre-payment review Demonstration	Modified

ICR Details

OMB Control No: 0938-1169	ICR Reference No: 201312-0938-007
Status: Historical Inactive	Previous ICR Reference No: 201205-0938-011
Agency/Subagency: HHS/CMS	Agency Tracking No: 21057
Title: Fee-for-Service Recovery Audit Prepayment Review Demonstration and Prior Authorization Demonstration
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 06/09/2014
	Date Received in OIRA: 12/09/2013
Terms of Clearance: Withdrawn

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2015	07/31/2015	07/31/2015
Responses	479,750	0	479,750
Time Burden (Hours)	243,060	0	243,060
Cost Burden (Dollars)	0	0	0

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Abstract: CMS is requesting PRA approval to collect medical records for 2 demonstrations in order to ensure proper payment of claims. The information required under this collection is requested by Medicare contractors to determine proper payment or if there is a suspicion of fraud. Medicare contractors may request the information from providers or suppliers submitting claims for payment from the Medicare program when data analysis indicates aberrant billing patterns or other information which may present a vulnerability to the Medicare program. For items with a history of aberrant billing patterns this information is requested in advance to determine appropriate payment or if there is a suspicion of fraud.

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Authorizing Statute(s): 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
   US Code: 42 USC 1395g Name of Law: Payment to providers of services
  

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

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Recovery Auditor Pre-payment review Demonstration
PMD Demonstration
Signature Attestation

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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: The burden has been adjusted to account for the expansion of the program. The per task burden remains the same.

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Annual Cost to Federal Government: $24,000,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 12/09/2013

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