[Federal Register Volume 77, Number 25 (Tuesday, February 7, 2012)]
[Notices]
[Pages 6123-6124]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-2821]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-10421]


Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Centers for Medicare & Medicaid Services, HHS.

    In compliance with the requirement of section 3506(c)(2)(A) of the 
Paperwork Reduction Act of 1995, the Centers for Medicare & Medicaid 
Services (CMS) is publishing the following summary of proposed 
collections for public comment. Interested persons are invited to send 
comments regarding this burden estimate or any other aspect of this 
collection of information, including any of the following subjects: (1) 
The necessity and utility of the proposed information collection for 
the proper performance of the agency's functions; (2) the accuracy of 
the estimated burden; (3) ways to enhance the quality, utility, and 
clarity of the information to be collected; and (4) the use of 
automated collection techniques or other forms of information 
technology to minimize the information collection burden.
    1. Type of Information Collection Request: New collection; Title of 
Information Collection: Fee-for-Service Recovery Audit Prepayment 
Review Demonstration and Prior Authorization Demonstration; Use: The 
Centers for Medicare & Medicaid Services (CMS) is requesting the Office 
of Management and Budget (OMB) approval of the collections required for 
two demonstrations of prepayment review and prior authorization. The 
first demonstration would allow Medicare Recovery Auditors to review 
claims on a pre-payment basis in certain States. The second 
demonstration would establish a prior authorization program for Power 
Mobility Device claims in certain States.
    For the Recovery Audit Prepayment Review Demonstration, CMS and its 
agents will request additional documentation, including medical 
records, to support submitted claims. As discussed in more detail in 
Chapter 3 of the Program Integrity Manual, additional documentation 
includes any medical documentation, beyond what is included on the face 
of the claim that supports the item or service that is billed. For 
Medicare to consider coverage and payment for any item or service, the 
information submitted by the provider or supplier (e.g., claims) must 
be supported by the documentation in the patient's medical records. 
When conducting complex medical review, the contractor specifies 
documentation they require in accordance with Medicare's rules and 
policies. In addition, providers and suppliers may supply additional 
documentation not explicitly listed by the contractor. This supporting 
information may be requested by CMS and its agents on a routine basis 
in instances where diagnoses on a claim do not clearly indicate medical 
necessity, or if there is a suspicion of fraud.
    For the Prior Authorization of Power Mobility Devices (PMDs) 
Demonstration, CMS will pilot prior authorization for Power Mobility 
Devices. Prior authorization will allow the applicable documentation 
that supports a claim to be submitted before the item is delivered. For 
prior authorization, relevant documentation for review is submitted 
before the item is delivered or the service is rendered. CMS will 
conduct this demonstration in California, Florida, Illinois, Michigan, 
New York, North Carolina and Texas based on beneficiary address as 
reported to the Social Security Administration and recorded in the 
Common Working File (CWF). For the demonstration, a prior authorization 
request can be completed by the (ordering) physician

[[Page 6124]]

or treating practitioner and submitted to the appropriate DME MAC for 
an initial decision. The supplier may also submit the request on behalf 
of the physician or treating practitioner. The physician, treating 
practitioner or supplier who submits the request on behalf of the 
physician or treating practitioner, is referred to as the 
``submitter.'' Under this demonstration, the submitter will submit to 
the DME MAC a request for prior authorization and all relevant 
documentation to support Medicare coverage of the PMD item.
    These demonstrations have been designed to develop and demonstrate 
improved methods for the investigation and prosecution of fraud in the 
provision of care or services under the health programs established by 
the Social Security Act. The information required under this 
information collection request is requested by Medicare contractors to 
determine proper payment or if there is a suspicion of fraud. For the 
RAC demonstration, 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. Under the prior authorization demonstration, for certain PMDs, 
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. Form Number: CMS-10421 (OCN 0938-New); Frequency: 
Occasionally; Affected Public: State, Local or Tribal Governments; 
Number of Respondents: 479,750; Total Annual Responses: 479,750; Total 
Annual Hours: 243,060. (For policy questions regarding this collection 
contact Debbie Skinner at (410) 786-7480. For all other issues call 
(410) 786-1326.)
    To obtain copies of the supporting statement and any related forms 
for the proposed paperwork collections referenced above, access CMS' 
Web Site address at http://www.cms.hhs.gov/PaperworkReductionActof1995, 
or Email your request, including your address, phone number, OMB 
number, and CMS document identifier, to [email protected], or call 
the Reports Clearance Office on (410) 786-1326.
    In commenting on the proposed information collections please 
reference the document identifier or OMB control number. To be assured 
consideration, comments and recommendations must be submitted in one of 
the following ways by April 9, 2012:
    1. Electronically. You may submit your comments electronically to 
http://www.regulations.gov. Follow the instructions for ``Comment or 
Submission'' or ``More Search Options'' to find the information 
collection document(s) accepting comments.
    2. By regular mail. You may mail written comments to the following 
address: CMS, Office of Strategic Operations and Regulatory Affairs, 
Division of Regulations Development, Attention: Document Identifier/OMB 
Control Number CMS-10161 (OCN 0938-0979), Room C4-26-05, 7500 Security 
Boulevard, Baltimore, Maryland 21244-1850.

    Dated: February 1, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-2821 Filed 2-3-12; 11:15 am]
BILLING CODE 4120-01-P