[Federal Register Volume 78, Number 20 (Wednesday, January 30, 2013)]
[Notices]
[Pages 6331-6332]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-01849]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[Document Identifier: CMS-276 and CMS-339]
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: Reinstatement with
change of a previously approved collection; Title: Prepaid Health Plan
Cost Report; Use: Health Maintenance Organizations and Competitive
Medical Plans (HMO/CMPs) contracting with the Secretary under Section
1876 of the Social Security Act are required to submit a budget and
enrollment forecast, semi-annual interim report, interim final cost
report, and a final certified cost report in accordance with 42 CFR
417.572-417.576. Health Care Prepayment Plans
[[Page 6332]]
(HCPPs) contracting with the Secretary under Section 1833 of the Social
Security Act are required to submit a budget and enrollment forecast,
semi-annual interim report, and final cost report in accordance with 42
CFR 417.808 and 42 CFR 417.810. CMS is requesting approval for the
reinstatement with change of Form CMS-276 (OCN: 0938-0165). This Cost
Report outlines the provisions for implementing Section 1876(h) and
Section 1833(a)(1)(A) of the Social Security Act. The purposes of the
revisions were to implement some changes in response to the Affordable
Care Act, clarify certain instructions, and update outdated issues
within the Cost Report. Form Number: CMS-276 (OMB 0938-0165);
Frequency: Annually; Affected Public: Private Sector--Business or other
for-profits and not-for-profit institutions; Number of Respondents: 29;
Total Annual Responses: 106; Total Annual Hours: 1,384. (For policy
questions regarding this collection contact Temeshia Johnson at 410-
786-8692. For all other issues call 410-786-1326.)
2. Type of Information Collection Request: Reinstatement with
change of a previously approved collection; Title of Information
Collection: Medicare Provider Cost Report Reimbursement Questionnaire;
Use: The purpose of Form CMS-339 is to assist the provider in preparing
an acceptable cost report and to minimize subsequent contact between
the provider and its Medicare Administrative Contractor (MAC). Form
CMS-339 provides the basic data necessary to support the information in
the cost report. Exhibit 1of Form CMS-339 contains a series of
reimbursement-oriented questions which serve to update information on
the operations of the provider. It is arranged topically regarding
financial activities such as independent audits, provider organization
and operation, etc. The MAC is responsible for the settlement of the
Medicare cost report and must determine the reasonableness and the
accuracy of the reimbursement claimed. This process includes performing
both a desk review of the cost report and an analysis leading to a
decision to settle the cost report with or without further audit. Form
CMS-339 provides essential information to enable the MAC to make the
audit or no audit decision, scope of the audit if one is necessary, and
to update the provider documentation (i.e., documentation to support
the financial profile of the provider). If the information is not
collected, the MAC will have to go onsite to each provider to get this
information. Consequently, it is far less burdensome and extremely cost
effective to capture this information through the Form CMS-339.
Exhibit 2 of Form CMS-339 is a listing of bad debts pertaining to
uncollectible Medicare deductible and coinsurance amounts. Preparation
of the listing is a convenient way for providers to supply the MAC with
information needed to determine the allow ability of the bad debts for
reimbursement. Some items required to determine allow ability that are
included on this exhibit are patient's name, dates of service, date
first bill sent to beneficiary, and date the collection effort ceased.
Supplying the MAC with this information may be all that is required for
the MAC to determine whether or not the bad debt is allowable. This too
may eliminate a visit to the provider to gather this needed data. Form
Number: CMS-339 (OCN: 0938-0301); Frequency: Yearly; Affected Public:
Private Sector--Business or other for-profits and not-for-profit
institutions; Number of Respondents: 17,939; Total Annual Responses:
17,939; Total Annual Hours: 53,817. (For policy questions regarding
this collection contact Christine Dobrzycki at 410-786-3389. 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 1, 2013:
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 ------------------, Room C4-26-05, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850.
Dated: January 24, 2013.
Martique Jones,
Deputy Director, Regulations Development Group, Office of Strategic
Operations and Regulatory Affairs.
[FR Doc. 2013-01849 Filed 1-29-13; 8:45 am]
BILLING CODE 4120-01-P