QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with DME Suppliers and Part A Providers (CMS-10633)

Forms and Documents

Document Name	Status
Form CMS-10633 Part A Providers Web-Based Survey Form and Instruction	New
Form CMS-10633 Part A Providers Key Informant Form and Instruction	New
Form CMS-10633 DME Suppliers Web-Based Survey Form	Modified
Form CMS-10633 DME Suppliers Key Informant Interview Form and Instruction	Modified
QDEC-SSA.docx Supporting Statement A	2020-09-24
QDEC-SSB.docx Supporting Statement B	2020-09-24

IC Document Collections

IC ID	Document Title	Status
243671	Part A Providers Web-Based Survey Form and Instruction	New
243670	Part A Providers Key Informant Form and Instruction	New
227305	DME Suppliers Web-Based Survey Form	Modified
227304	DME Suppliers Key Informant Interview Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1348	ICR Reference No: 202009-0938-010
Status: Received in OIRA	Previous ICR Reference No: 201706-0938-005
Agency/Subagency: HHS/CMS	Agency Tracking No: CM-FFS
Title: QIC Demonstration Evaluation Contractor (QDEC): Analyze Medicare Appeals to Conduct Formal Discussions and Reopenings with DME Suppliers and Part A Providers (CMS-10633)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/25/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2021
Responses	5,288	2,640
Time Burden (Hours)	950	473
Cost Burden (Dollars)	0	0

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Abstract: The Formal Telephone Discussion Demonstration and Reopenings Process is authorized under Section 402(a)(1)(F), U.S.C.§ 1395-1(a)(1)(F)1, of the Social Security Amendments of 1967. Primary and secondary data are needed to understand the effectiveness of the Demonstration in improving suppliers’ understanding of claims denial during Level 2 of the appeals process and facilitating more accurate claim submission over time. Primary data are necessary to determine, from the perspective of participating suppliers, the quality of the formal telephone discussions, satisfaction with the formal telephone discussion process, and the effect of the formal telephone discussions on suppliers’ understanding of submitting accurate claims.

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Authorizing Statute(s): US Code: 42 USC 1395b-1 Name of Law: INCENTIVES FOR ECONOMY WHILE MAINTAINING OR IMPROVING QUALITY IN THE PROVISION OF HEALTH 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
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 39568	07/01/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 60169	09/24/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
DME Suppliers Key Informant Interview	CMS-10633	Key Informant Interviews
DME Suppliers Web-Based Survey	CMS-10633, CMS-10633	DME Survey Screenshots ,   Web Based Surveys
Part A Providers Web-Based Survey	CMS-10633, CMS-10633	Web Based Surveys ,   Part A Survey Screenshots
Part A Providers Key Informant	CMS-10633	Key Informant Interviews

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ICR Summary of Burden

	Total Request	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	5,288	2,640	0	0	2,648	0
Annual Time Burden (Hours)	950	473	0	0	477	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: Estimated Annualized Burden Hours have increased from 473 hours to 950 due to the addition of the Part A provider respondents.

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Annual Cost to Federal Government: $145,116

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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? No

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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: 09/25/2020

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