[Federal Register Volume 63, Number 123 (Friday, June 26, 1998)]
[Notices]
[Pages 34903-34904]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-16989]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-R-224]
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Health Care Financing Administration, HHS.
In compliance with the requirement of section 3506(c)(2)(A) of the
Paperwork Reduction Act of 1995, the Health Care Financing
Administration (HCFA), Department of Health and Human Services, 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.
Type of Information Collection Request: Extension of a currently
approved collection; Title of Information Collection: Collection of
Managed Care Data Using the Uniform Institutional Providers Form (HCFA-
1450/UB-92) and Supporting Statute Section 1853(a)(3) of the Balanced
budget Act of 1997; Form No.: HCFA-R-224 (OMB No. 0938-0711); Use:
Section 1853(a)(3) of the Balanced Budget Act (BBA) requires
Medicare+Choice organizations, as well as eligible organizations with
risk-sharing contracts under section 1876, to submit encounter data.
Data regarding inpatient hospital services are required for periods
beginning on or after July 1, 1997. These data may be collected
starting January 1, 1998. Other data (as the Secretary deems necessary)
may be required beginning July 1, 1998.
The BBA also requires the Secretary to implement a risk adjustment
methodology that accounts for variation in per capita costs based on
health status. This payment method must be implemented no later than
January 1, 2000. The encounter data are necessary to implement a risk
adjustment methodology.
Hospital data from the period, July 1, 1997-June 30, 1998, will
serve as the basis for plan-level estimates of risk adjusted payments.
These estimates will be provided to plans by March, 1999. Encounter
data collected from subsequent time periods will serve as the basis for
actual payments to plans for CY 2000 and beyond.
In implementing the requirements of the BBA, hospitals will submit
data to the managed care plan for enrollees who have a hospital
discharge using the HCFA-1450 (UB-92), Uniform Institutional Provider
Claim Form. Encounter data for hospital discharges occurring on or
after July 1, 1997 are required. While submission from the hospital to
the plan is required, plans are provided with an alternate submission
route for the start-up year.
Special procedures have been identified to ensure that hospital
encounter data are submitted for discharges occurring between July 1,
1997 and June 30, 1998, the start-up year. HCFA has identified three
alternatives for the submission of hospital encounter data for
discharges during the star-up year, including the following:
Option 1: The Plan will have a hospital submit UB-92s or Medicare Part
A ANSI ASC X12 837 (ANSI 837) records using the traditional HMO ``No
Pay'' bill method.
Option 2: The Plan can currently produce a complete UB-92/ANSI 837 and
will hold the data until the fiscal intermediary (FI) can accept it.
Option 3: The Plan will submit an abbreviated UB-92 data set via an
alternative route.
During the start up year, the plan is expected to establish an
electronic data linkage to a FI to be determined by HCFA. HCFA will
assist Plans in initiating discussions with their FI. By July 15, 1998,
the Plan is expected to have completed this linkage, including testing
of the linkage, and to be capable of transmitting hospital encounter
data to a FI. Data for the start-up year must be transmitted to the
plan's FI by September, 18, 1998. All data with discharge dates after
July 1, 1998 will be transmitted using this linkage. (See Appendix III
for additional information on the transmission of data to HCFA.) Each
plan and/or contract will use a single FI. HCFA will establish a series
of interim deadlines to ensure that plans are making sufficient
progress toward
[[Page 34904]]
accomplishing this linkage no later than July 15, 1998.
After plans have established linkages to a FI, hospitals will
submit HCFA-1450 (UB-92) forms to the managed care plan. The HCFA-1450
(UB-92) form is identical to the one used by hospitals in billing for
Medicare fee-for-service claims. After receiving the pseudo claim from
the hospital, the plan attaches the plan identifier, which is the HCFA
assigned managed care organization (MCO) Contract Number, and submits
the pseudo-claim electronically to the fiscal intermediary (FI). The
data processing flow by the FI is very similar to current claims
processing for the fee-for-service system, except that no payment is
authorized to the plan. Pseudo claims will flow though the FI to our
Common Working File (CWF) and will be retained by HCFA.; Frequency: On
occasion; Affected Public: Business or other for-profit, Not-for-profit
institutions, and Federal government; Number of Respondents: 1.9
million; Total Annual Responses: 1.9 million; Total Annual Hours:
32,833.
To obtain copies of the supporting statement and any related forms
for the proposed paperwork collections referenced above, access HCFA's
Web Site address at http://www.hcfa.gov/regs/prdact95.htm, or E-mail
your request, including your address, phone number, OMB number, and
HCFA document identifier, to P[email protected], or call the Reports
Clearance Office on (410) 786-1326. Written comments and
recommendations for the proposed information collections must be mailed
within 60 days of this notice directly to the HCFA Paperwork Clearance
Officer designated at the following address: HCFA, Office of
Information Services, Security and Standards Group, Division of HCFA
Enterprise Standards, Attention: Louis Blank, Room C2-26-17, 7500
Security Boulevard, Baltimore, Maryland 21244-1850.
Dated: June 16, 1998.
John P. Burke III,
HCFA Reports Clearance Officer, HCFA Office of Information Services,
Security and Standards Group, Division of HCFA Enterprise Standards.
[FR Doc. 98-16989 Filed 6-25-98; 8:45 am]
BILLING CODE 4120-03-P