Beneficiary and Family Centered Data Collection (CMS-10393)

Information collection activities for the Beneficiary and Family Centered Information Collection include the following: Experience Survey: The population is comprised of Medicare beneficiaries who received support from a QIO with an appeal or complaint case. The sample will be stratified, analyzed, and reported by case type: • Appeal stratum – A simple random sample will be drawn of approximately 3 percent (9,000) of the annual universe (n=350,000). No sub-stratum oversampling will be used. This is expected to yield sufficient data to support quarterly analytic and evaluation reporting. • Complaint medical record review stratum - Given the relatively small annual volume (n=1,500), a census will be drawn in order to yield sufficient data for quarterly analytic and evaluation reporting. • Immediate advocacy stratum - A simple random sample will be drawn of approximately 30 percent (4,500) of the annual universe (n=15,000). No sub-stratum oversampling will be used. This is expected to yield sufficient data for quarterly analytic and evaluation reporting. Information collection will be conducted via telephone with paper surveys sent by mail upon request, and for those who do not respond by telephone. Data will be collected monthly with the annualized sample and burden hours allocated evenly across 12 months.

The latest form for Beneficiary and Family Centered Data Collection (CMS-10393) expires 2027-01-31 and can be found here.