(Medicare General Information, Eligibility, and Entitlement)

Information That May Not Be Disclosed   If a provider chooses to submit with its cost report additional information not specifically required by regulations or instructions, the contractor should not disclose such information unless it is contained within an official document or the equivalent thereof. For example, some providers may submit supplementary analyses of certain expenses, details of the  professional component adjustment, financial statements (other than the statement of income and expenses and the balance sheet as required in accordance with cost reporting instructions), or income tax returns that are not required by the program.  These would not be disclosable by the contractor.   Except where a provider has not submitted an acceptable cost report and supplements are required to complete the report, any additional documents or schedules that the contractor requires the provider to submit in support of its cost representations are also not to be disclosed.  In addition, do not disclose audits, schedules, letters, notes, and comments; comments on results of desk reviews (including copies of the actual desk review documents); contractor notes  and comments (including transmittal letters); audit adjustment summaries that contractors and auditors are required to prepare; and information pertaining to an individual patient.  Contractors acknowledge such requests and refer them to the regional offi ce.  NOTE:   Cost report information that the contractor may not disclose may, nevertheless, be disclosed under the Freedom of Information Act by the CMS regional office, central office or, upon appeal of a denial, by the Administrator, CMS.  Upon judicial review, a U. S. District Court may order Disclosure.   When an A/B MAC (A) or (HHH) discloses a settled report, it may disclose schedules applicable to the settlement that have been reworked.  The general rule is that if the contractor has reworked any of t he schedules that the provider is required to submit with its original submission, these schedules become an integral part of the report for disclosure purposes.  However, the A/B MAC (A) or (HHH) may not disclose any details containing contractor or audit or comments concerning the settlement, details of specific adjustments, or supporting schedules applicable to the settlement of the provider's operation.  Prior to the release of cost report information to the requestor, the A/B MAC (A) or (HHH) servicing the provider must screen each cost report and remove non- disclosable documents and information.  If the A/B MAC (A) or (HHH) is uncertain whether a particular document must be disclosed it should consult the regional office in the region in which the provi der is located.  Further, if the A/B MAC (A) or (HHH) discovers as a result of review that the cost report reflects information that might result in adverse program publicity, it alerts the RO immediately.  However, it does not delay disclosure.   The above  instructions do not negate in any manner the requirement that the A/B MAC (A) or (HHH) submit cost reports to CMS that contain full and complete information, including the details of all contractor and auditor adjustments, comments, and any supporting sch edules that may be needed to verify the settlement.   5.  Responding to Requests for Inspection of Cost Reports   The A/B MAC (A) or (HHH) will make cost reports available for inspection by the requestor at the A/B MAC (A) or (HHH)'s office during regular business hours.  In addition, arrangements will be made to make copies available upon specific request at any RO, or at central office.  The A/B MAC (A) or (HHH) must provide appropriate space for such inspections.  It must establish procedures to ensure tha t all reports inspected are properly accounted for.  Under no circumstances should it permit any requester to remove cost reports from the place of inspection.  If the requester has questions with respect to the interpretation or analysis of cost report information, the A/B MAC (A) or (HHH) will advise the requester to submit such requests for more than routine explanations in writing to the regional office.   6.  Disclosure of Cost Reports   If a request is received to inspect or to obtain a copy of a report  that has not been settled; i.e., the final settlement notice of program reimbursement has not been sent, the A/B MAC (A) or (HHH) will disclose a copy of the report as submitted by the provider.  If settlement has been made, it will disclose the settled r eport.  If a requester specifically asks for both the settled and unsettled cost reports of a provider, the A/B MAC (A) or (HHH) will comply.  When a report is made available for inspection or copying, it should be clearly marked with one of the following captions, as applicable.   Cost report as submitted:    Settlement subject to audit; and   Audited settlement.  Requests for reproduction of all or part of a provider's cost report may be subject to photocopy fees.  If it is determined that a fee must be charged, the A/B MAC (A) or (HHH) prepares the written response to the requester in accordance with  20 and 20.4  of this chapter.   7. Responding to Requests for Information   A requester may desire only selected cost report information of a provider or several providers.  However, the DHHS Freedom of Information Regulation specifies that agencies are not required to create a reco rd by compiling selected items from the files; such requests will be met by furnishing copies of specific documents which contain the information requested.  In addition, when the contractor receives a request that requires selecting documents from various  cost reports, the request should be honored.  It will follow the written response procedure above even though the entire report is not being disclosed.  It will advise the requester that a searching fee will be charged and give an approximate date when th e documents will be ready.   D. Medicare Payment and Cost Data  The A/B MAC (A) or (HHH) may release Medicare payment or Medicare cost data concerning a named provider without giving the provider the ten- day notice required in 10.2 or 30  above.  However, it does not give the requester enough information to calculate provider non -Medicare data as well.  For example, A/B MACs (A) o r (HHH) do not tell a requester that Medicare payments to the provider represent 30 percent of its total revenues.   The Medicare payment or Medicare cost data may be extracted from such documents as cost reports or Form CMS -3286, Monthly Actuarial Sample of Hospital Reimbursement.  Any extraction of data is subject to the instructions above concerning creation of records.   E. Waiver of Liability Status   The waiver of liability status of a particular provider and the statistics used to determine that status may be disclosed.  140.3 - Disclosure of Information About Named Physicians and Other Suppliers of Service (RO's)  (Rev. 1, 09- 11-02)  A. General   Generally, the contractor will not honor requests for information about a specific physician or other supplier of services, or for information which would identify such a physician or other supplier of services, except in situations described in 140.1  above.  Disclosure to third parties for program purposes of information about individual physicians and other suppliers who are natural persons is governed by the same restrictions and procedures as disclosure about named beneficiaries to third parties for program purposes.  (See 50B of this chapter.)  The contractor acknowledges such requests and refers them to the RO for respons e.  If the information the contractor discloses is solely information that does not identify or make identifiable individuals (e.g., aggregate statistics or records on providers and other corporate entities), it uses the following language:   Dear:   We are prepared to make available to your organization certain social security records so that (state reason).   However, before making these records available to you, we must point out that by law all information derived in the administration of the Social Security Act is subject to the provisions of the Freedom of Information Act, which exempts from disclosure certain categories of records.  In order to assure that no records held confidential under the Freedom of Information Act are disclosed, you must agree to meet the following conditions before we make any social security records available to you:   1. Any information which is turned over to you will be used only for the specific purpose intended and for no other purpose.   2. All employees having access to this  material will be instructed as to its confidential nature.  3. An official of your company will assume responsibility for ensuring that the information is not revealed to any other party.   4. The material must be returned to us as soon as you have finishe d the job.   5. We must have a letter from a responsible official in your office agreeing to these conditions and assuming responsibility for carrying them out.   Upon receipt of this letter from your organization, the social security records will be made av ailable to you.   Sincerely yours,   If the contractor receives a written request for a physician's or supplier's customary charges or for amounts of program payments made to physicians outside of its jurisdiction, it acknowledges the request and sends it to the appropriate contractor, when known.  If not known, it sends the request to the RO.  Disclosure of information about unidentifiable individuals, or about provider or corporate entities (e.g., clinics or independent laboratories) is not to be disclosed by third parties to which information is disclosed for program purposes.  B. Physician Fee and Supplier Charge Information   Customary charges may be disclosed to the public.  However, requests from anyone (including a physician or supplier) for actual data  used to determine the customary charge(s) should be referred to the RO.   A/B MACs (B) or DME MACs may voluntarily specify a physician's or supplier's customary charges when explaining reimbursement or when furnishing denial or review notices.   The A/B MAC  (B) or DME MAC may furnish a physician or supplier with a copy of their own customary charges free of charge; requests for customary charges from other sources will be subject to FOIA fees.  However, anyone may inspect the customary charges free at the of fice of the A/B MAC (B) or DME MAC serving the locality for which the screens are used.  A/B MACs (B) or DME MACs produce a printout to be made available for inspection and/or photocopying in their office.  If past experience with requests for customary charge screens from the public does not warrant the expense of producing a printout of all screens for inspection (i.e., there have been few request and no one has requested to inspect all the screens), printout copies of single screens or small numbers of s creens may be furnished instead of photocopies; however, there will be no charge for the computer time for the printout nor shall the requesters be asked to pay more than they would if they were to request a photocopy of the screens.  Requests specifically  for printouts or tapes shall be furnished at cost to related Federal programs (for example, to TRICARE or Medicaid).   A/B MACs (B) or DME MACs may release information to the public regarding the method used to determine Medicare allowances, e.g., that the  median of the charges made by physician for a service is used as the customary charge, and that the 75th percentile of such customary charges in an area (weighted by frequency of service) is used to establish the prevailing charge.   Written requests for l ists A/B MACs (B) or DME MACs do not have should be referred to the RO immediately by telephone so that RO can indicate whether the A/B MAC (B) or DME MAC should create a list.  Such request might be for all the customary charge screens of internists in a given county or for a list of all physicians who charge a given amount or less for a certain procedure.  If requesters orally ask to see a list, which does not exist, the A/B MAC (B) or DME MAC will offer them the opportunity to inspect the screens and create their own list.   C. Disclosure of Related Entrepreneurial Information   Information such as the specialty and business address of a physician or supplier may be disclosed to the public.  The A/B MAC (B) or DME MAC will refer to the RO written requests f or special lists, such as a list of five orthopedists in a given city.  However, if the A/B MAC (B) has processed a list of all orthopedists in that city, it may, upon request, disclose the entire list.  It may fulfill oral requests by offering the requester the opportunity to look at whatever disclosable records (e.g., customary charge screens) there are that contain the data (or to purchase photocopies of the data) or by referring the requester to the medical society or licensing board in the requester's area, if appropriate.   140.4 - Disclosure of Names of Providers, Physicians, and Suppliers of Services  (Rev. 1, 09- 11-02)  140.4.1 - Names of Providers Terminated from Program Participation (A/B MACs (B) or DME MACs ) (Rev. 1, 09- 11-02)