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[Federal Register Volume 77, Number 185 (Monday, September 24, 2012)]
[Notices]
[Pages 58847-58848]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-23367]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[Document Identifier: CMS-846-849, 10125 and 10126]

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

[[Page 58848]]

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: Extension of a currently 
approved collection;
    Title: Durable Medical Equipment Medicare Administrative Contractor 
Certificate of Medical Necessity and Supporting Documentation 
Requirements; Use: The certificates of medical necessity (CMNs) collect 
information required to help determine the medical necessity of certain 
items. CMS requires CMNs where there may be a vulnerability to the 
Medicare program. Each initial claim for these items must have an 
associated CMN for the beneficiary. Suppliers (those who bill for the 
items) complete the administrative information (e.g., patient's name 
and address, items ordered, etc.) on each CMN. The 1994 Amendments to 
the Social Security Act require that the supplier also provide a 
narrative description of the items ordered and all related accessories, 
their charge for each of these items, and the Medicare fee schedule 
allowance (where applicable). The supplier then sends the CMN to the 
treating physician or other clinicians (e.g., physician assistant, LPN, 
etc.) who completes questions pertaining to the beneficiary's medical 
condition and signs the CMN. The physician or other clinician returns 
the CMN to the supplier who has the option to maintain a copy and then 
submits the CMN (paper or electronic) to CMS, along with a claim for 
reimbursement. This clearance request is for CMNs with the form 
numbers, CMS 846-849, 10125 and 10126. Form Numbers: CMS-846, 847, 848, 
849, 10125, 10126 (OCN: 0938-0679); Frequency: Occasionally; Affected 
Public: Individuals or Households; Number of Respondents: 462,000; 
Total Annual Responses: 462,000; Total Annual Hours: 92,400. (For 
policy questions regarding this collection contact Doris Jackson at 
410-786-4459. 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 Paperwork@cms.hhs.gov, 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 November 23, 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 -------- , Room C4-26-05, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850.

    Dated: September 18, 2012.
Martique Jones,
Director, Regulations Development Group, Division B, Office of 
Strategic Operations and Regulatory Affairs.
[FR Doc. 2012-23367 Filed 9-21-12; 8:45 am]
BILLING CODE 4120-01-P
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