(General Information, Eligibility, and Entitlement Manual)

B. Formally authorize official file locations.  Prohibit the  maintenance of files at other than authorized locations.  C. Standardize reference service procedures to facilitate the finding, charge -out, and refiling of records.   D. File accumulations of papers received at file locations on a daily basis.   E. Audit periodically a representative sample of the files for duplication, misclassification, or misfiles.  In addition to the above, the contractor's program must:   1. Establish and implement standards and procedures issued by CMS.  Such CMS standards and procedures relate to:   a. Classifying, indexing, and filing records;   b. Providing reference services to filed records;   c. Locating active files to facilitate use of the records; and   d. Reviewing the program periodically to determine the adequacy of the system and its effectiveness in meeting requests.   2. Ensure that the standards, guides, and instructions developed for the files management program are readily available to all employees concerned with the files operations.  In addition, give pertinent information for user s of files and references services the widest possible dissemination.   3. File accumulations of papers received at file locations on a daily basis.   4. Audit periodically a representative sample of the files for duplications, misclassification, or misfiles.   The methods used in maintaining, using, and disposing of these files vary with the contractor.  Variations depend on the filing and control methods established (e.g., provider number, Medicare beneficiary identifier , date, name, or other sequence) to record r equests from providers; to furnish replies; to check on overdue cases; to control cases for completion of processing; to control cases requiring some type of investigation or additional documentation; to retain completed cases for history or other reference; to maintain for audits; and to schedule for transfer to other storage areas.  Other variances may be due to computer or clerical practices; workload volume; review initiated at time of notice of admission, at time of start of care, at time of request fo r advance payment or at time of receipt of billing form; and other considerations.  30.30 - Record Retention and Disposal Schedule  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  This schedule identifies those records accumulated by the contractor in administering the Medicare program and outlines the disposal schedule for each type of record.  A freeze has been imposed on the destruction of Medicare records.  No paper Medicare records can be destroyed unless they are electronically imaged.  If Medicare records are not imaged, the original paper document must be retained.  A contractor who images paper Medicare records:   A. Must always be able to demonstrate the imaged version is an exact copy of the paper document,  B. Docume nt the steps taken to image the original document,   C. Establish and implement a certification/quality assurance process to ensure the imaged information is an identical replication of the paper document in every way,   D. Retain the scanned image as the recordk eeping copy for the required retention period, and  E. Maintain accessibility and the ability to read the document in accordance with changes in technology.   The methods used in imaging files may vary with the contractor.  These variations depend on the type of equipment used and methods used to prepare documents for imaging.  All imaged documents shall be tamper proof.  Once an image is verified as an exact copy of the original paper document, only then can the original paper document be destroyed and the im aged copy is certified as the recordkeeping copy.   Certifying images as an exact copy of the paper document means there is a "quality assurance" process in place that verifies that the images are good.  Each contractor is responsible for establishing the ir own "quality assurance" procedures.   Below is an example of a certification/quality assurance process.   1.  The staff member performing the actual scan will:   a.  Observe that all pages successfully pass through scanner and that image displayed on the imaging software preview screen appear accurate.   b.  Affix a sticker marked Scanned to the top page, write the current date on the sticker and place on top of a pile of scanned material.  2.  The staff member(s) responsible for these records will have i mmediate access to the images, from their desktops, using the imaging software.  They will have 30 days to use and review the images.  If any problem is detected, the paper will be retrieved and rescanned.  After 30 days, the paper copies are subject to pr oper disposal.   A contractor is authorized to cut off and transfer Medicare claims records and other records to inactive storage earlier than is prescribed in the disposal schedule shown below when the records are contained on microform.  (See 40.3 and .50ff. for guidelines on retention and disposition guidelines on microform copies of the following records.)   The term "cut off" means the transfer of records to an inactive files area when there is no more than one reference to a file drawer per month.  Se e 30.70  for guidelines regarding the disposition of non- claims material not transferred to inactive storage.   30.30.1 - Disposition Instructions - Destruction of Records  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06 -26-06)  In accordance with Federal regulations, 36 CFR 1228.58(b) -Destruction of Temporary Records, http://www.access.gpo.gov/nara/cfr/waisidx_05/36cfr1228_05.html  paper records to be disposed of normally must be sold as wastepaper.  Because the records you maintain are considered restricted, you are required to pulp, macerate, shred, or otherwise definitely destroy the information contained in the records and their destruction must be witnessed by you who created the records or by a contractor employee (see Exhibit 11, Witness Disposal Certification -Sample) .  The contract for sale must prohibit the resale of all other paper records for use as records or documents.  Regardless of medium, records other than paper records (e.g., audio, visual, data tapes, disks, diskettes, etc.) may be salvaged and sold in the same manner and under the same conditions as paper records.  A Witness Disposal C ertification must be completed and kept on file for 7 years.   30.30.1.1 - Disposition Instructions When Operating Under a Freeze  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  When operating under a freeze, you are prohibited f rom destroying records, and must follow the disposition instructions below in 30.30.1.2 .  Only after the freeze has been lifted, can you revert back to the normal disposition instructions in 30.30.2.   30.30.1.2 - Disposition Instructions When Medicare Records are Microfilmed  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Paper Records   All paper claims that are microfilmed must be retained until CMS notifies you the f reeze is lifted.   Microform Records   The master microform must be retained until CMS notifies you the freeze is lifted.   30.30.1.3 - Disposition For Paper -Only Medicare Records  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  The contractor cuts off the file at the close of the calendar year in which the claim was paid, then transfers the paper records to inactive storage.  The paper records must be retained until CMS notifies you the freeze is lifted.   30.30.1.4 - Disposition For  Medicare Records that are Imaged/Scanned  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Paper   Since imaging can be used to replace paper documents, only when the image will be identical  to the paper, you must image/scan both the front and the back of every document.  There is an exception:  Once the back of a claim form is imaged, you do not have to image the back of the rest of the documents imaged on that particular machine, as long as the backs are identical and a certified  statement is kept on file stating the remainder of the backs of the claim forms are identical.  However, if the back of a claim form differs in any respect, it must be imaged.   The contractor must retain the paper records until their certification/quality assurance process (see below) has been completed and the imaged information (the recordkeeping copy) is verified as an identical replication of the paper document.  Only then can the paper records be destroyed.   If a scanned document is not identical to the paper document, that paper document must be retained until the freeze is lifted.   Imaged/Scanned Records   Due to the freeze prohibiting the destruction of Medicare records, do not destroy any images of claims records.  They are the recordkeeping copy and must be retained until CMS notifies you the freeze is lifted.  Once the freeze is lifted, revert back to the normal disposition instructions in 30.30.2.  Sample Quality Assurance Procedure   Certifying images as an exact replication of the paper document means there is a "quality assurance" process in place that verifies that the images are good.  Each contractor is responsible for establishing their own "quality assurance" procedures.  Below is an example of a quality assurance process.   Standard Procedures for Document Imaging Quality Assurance  1. The staff member(s) performing the actual scan will:   a. Observe that all pages successfully pass through scanner and that image displayed on the imaging software preview screen appear accurate.   b. Affix a sticker marked Scanned to the top page, write the current date on the sticker and place on top of a pile of scanned material.   2. The staff member(s) responsible for these records will have immediate access to the images, from their desktops, usi ng the imaging software.  They will have 30 days to use and review the images.  If any problem is detected, the paper will be retrieved and rescanned.  After 30 days, the paper copies are subject to proper disposal.   30.30.1.5 - Disposition for Medicare Re cords When Potential Fraud or Overutilization Has Been Identified  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  When potential fraud or overutilization has been identified, retain the recordkeeping copy onsite.  If the recordk eeping copy has already been transferred to offsite storage, retrieve and retain onsite until the investigation and subsequent legal action, if any, has been completed (including the exhaustion of all appeals), then destroy 3 months thereafter.   If at the close of this period, the disposition instructions shown in 30.30.1.1 through 30.30.2 remains applicable, retain, transfer, and destroy in accordance with the disposition instructions.  If the disposition instructions in 30.30.1.1 through 30.30.2 are no longer applicable, then destroy after the 3 month period following completion of the investigation or subsequent legal action, if any.   If any records are provided to a prosecutorial agency as evidentiary matter, consider such records as disposed of.  If a ny such record is returned by the prosecutorial agency, retain for 3 months, then destroy in accordance with the foregoing disposition instructions unless otherwise directed by the prosecutorial agency.   30.30.2 - Description of Records (Rev. 124, Issued: 05- 17-19, Effective: 06- 18-19, Implementation: 06- 18-19  The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes.   1. Medicare Clai ms Records:   A. A/B MAC (A) or (HHH) Billing Records ( FROZEN -  DO NOT DESTROY)   These files consist of Inpatient and/or Outpatient Billing forms, and other documents used to bill for services processed by A/B MACs (A) or (HHH)  i.e., inpatient hospital, outpatient hospital, SNF, hospice, home health, etc.  DISPOSITION:  Once the freeze is lifted, cutoff at the close of the CY in which paid.  Destroy 6 years and 3 months after cutoff.   B. A/B MAC (B) or DME MAC Billing Records (FROZEN -  DO NOT DESTROY)