(Medicare General Information, Eligibility, and Entitlement)

RCPs are available to the public at the RO servicing the contractor.  The contractor will refer requests for RCPs to the RO for response.  It will refer requests for an RCP of a multi- State contractor to the RO servicing the home office of the contractor.   The contractor will refer requests for supporting documentation for the RCP contained in Contractor Performance Evaluation (CPE) reports to the RO.  150.2 - Disclosure of Medicare Audit Reports to the Press and Public (Audit Agency)  (Rev. 1, 09- 11-02)  DHHS Audit Agency reports issued to Medicare contractors are available if requested, to members of the press and the public.  The contractor will refer requests for DHHS Audit Agency reports directly to the Audit Agency, which is responsible for decisions regarding the release of these reports.   160 - Disclosure of Statistics (CMS or Contractors) - (Rev. 1, 09- 11-02)  CMS and its agents may disclose statistical data and similar information that does not relate to any identifiable person or persons.  However, they are not required to create records for requestors by compiling selected items from the files, nor are they required to create records to pro vide such data as ratios, proportions, percentages, per capitas, frequency distributions, trends, correlations or comparisons.  They may, however, create such records when efficient administration permits.  Final authority to determine when "efficient admi nistration permits" rests with CMS.  The contractor will refer requests for information, which can be created by hand, to the RO unless the requestor is willing to accept copies of the pages containing the data needed to compile the requested information ( i.e., the requester is willing to do the necessary compilation).  The contractor will refer requests for information, which must be created by machine (e.g., computer programs to manipulate data and print results), to the RO.  CMS and the contractors have a joint obligation to ensure that the program is clearly and accurately represented and that the public is given a complete picture of program performance.   There are certain problems in accurately representing program performance by means of statistical d ata alone, since some groupings of statistics are subject to inadvertent inaccuracies or are susceptible to misinterpretation.  Careful judgment is, therefore, essential in presenting information on operating and payment activities.   160.1 - Information Th at the Contractor May Disclose  (Rev. 1, 09- 11-02)  When considered appropriate, the contractor may release operating, payment, and cost data listed below without prior approval of the RO.  The contractor will promptly forward to the RO a copy of information provided under this guideline.   In releasing any data under this guideline, the contractor must insure that the data are related specifically to the geographical area for which the contractor is responsible.  For example, if a press inquiry is clearly fo r the purpose of presenting program operating data for a geographical area beyond the jurisdiction of the contractor, and CMS has not made such data available for public release, the contractor will tell the requestor that it does not have the authority to release information beyond its operational jurisdiction. It will refer the request to the RO.  (See 160 ff of this chapter.)  In releasing payment data, the contractor must indicate that the  information refers only to the area it services and does not include payments to direct dealing providers, group practice prepayment plans, or railroad beneficiaries.   If it is not clear whether information can be released under this guide, the contractor  will resolve doubt in favor of obtaining prior clearance from the RO.   The data released under this guideline should be based on the figures furnished to CMS in the monthly financial report and the monthly workload report.  The administrative cost informa tion should be the same as in the quarterly Operations Schedule -Cumulative Interim Expenditure Report.  The following data, relating only to the contractor's title XVIII workload, may be released:    Benefit amounts paid by the contractor, including:   o Aggregate amounts, or   o Amounts broken out by category; e.g., inpatient hospital, outpatient hospital, etc., or   o Amounts broken out by provider, including interim rates, and cost reports.  (See also 140.1  of this chapter.)    Total number of bills or claims paid by the contractor, either as an aggregate or broken out by category.   Total number of bills processed.    Admission notices, by category, i.e. inpatient hospital, skilled nursing facil ity, home health agency.  (Extreme caution must be exercised to assure that this statistic is properly related to the items shown above.)    Claims volume as an aggregate amount, or broken out by category.    Median claims processing time, by category.  Proces sing time is derived by subtracting date of receipt from date of approval for payment using the dates shown on bills.   Any data determined from the data in items 1 -6 above and related data available to the public (e.g., average payment per paid claims).   Total administrative cost.    Average (arithmetic mean) cost per bill or claim processed.    Number or percentage of claims requiring contact with providers for further development.   Contractor -completed CMS forms and reports listed chronologically by form number.  Refer requests for CMS generated reports to the RO.  o Form SSA -1522 (Monthly Workload Report)   o Form SSA -1523 (Estimate of Administrative Costs and Credits)   o Form SSA -1566 (Intermediary Workload Report)   o Form SSA -1566 Supplement (1972 Amendment Supplem ent to Intermediary Workload Report)   o Form SSA -1615 (Operations Schedule -  Final Administrative Cost Proposal)   o Form SSA -1822 (Monthly Provider Audit Activity Report -Schedule I)   o Form SSA -1822A (Final Summary of Audits Completed During Quarter -Schedule II)   o Form SSA -1822B (Costs Accrued During Quarter, Cumulative Costs by Contract and FY, Schedule III)   o Form SSAz -2580 (Cost Classification Report)   o Form CMS -2582 (Plan of Expenditures)   o Form CMS -2598 (Budget Distribution)   o Form CMS -3208 (Provider Audit Cost Report)   o Form CMS -1527 (Operations Schedule -  Cumulative Interim Expenditure Report and Budget)   Release of the last form should be accompanied by a qualifying statement such as the following:   "This report is based on preliminary data and is subject to adjustment by subsequent cumulative reports and a final cost proposal."   Absent prior RO clearance, the contractor may release only the data listed above.  A request for data not included in the above list may, in the contractor's judgment, require an immediate response.  If so, the contractor may furnish general comments but cannot provide statistics.  No further action need be taken on these requests unless the requestor asks for additional information.  When additional information is requested, the contrac tor refers the request to the RO.   160.2 - Information That May Be Released Upon Authorization by the Regional Office  (Rev. 1, 09- 11-02)  The CMS regional office may authorize contractors to release the following information:  Total man -years (or man -quarte rs, etc.) employed per report period.   Man-hours per claim or bill processed.   Number of weeks' work on hand.  Denial rates.   Percent of claims or total payments involving reduction in charges.  Data which contrast one contractor's performance with the performance of any other contractor, or which compare a contractor's performance with any set of national, regional, or other combined contractor performance data, may not be released by the contractor without prior RO approval.  The contractor refers requests for  such information to the RO.  Generally, data of this type will be made available in periodic CMS releases when sufficient to permit valid statistical inferences.  When the release of this kind of information is considered valuable for contractor or progra m public relation, telephone request and approval for contractor release may be appropriate.   This section applies only to data compiled in the administration of the health insurance program. The contractor does not need prior RO approval to release, for example, compilations created by the Blue Cross Administration (BCA) or The National Association of Blue Shield Plans (NABSP).   Data pertaining to more than one contractor or which compare contractor performance may be released only in proper perspective.  Essentially, cost information alone is not an accurate indication of a contractor's performance and, therefore, is not to be publicized without other relevant data accompanying it; e.g., information pertaining to workload volume and processing time.  More over, release should always be accompanied by an interpretive statement indicating the limitations of the data and the known variables; e.g., wage differentials.   Requests which include a provider population beyond the jurisdiction of the contractor may involve data which have not been made available by CMS for public release.  Requests for such combined data will be handled by the RO, which, if it approves the release, will furnish the requestor with the appropriate combined data and alert the contractor s involved regarding the release.   170 - Disclosure of Health Insurance Information by Providers  (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 benef iciary'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.   Records and information, acquired in the administration of the Medicare program, may be disclosed only under prescribed rules and regulations or under the authority of the Administrator of CMS.  Information furnished specifically for purposes of a claim under the health insurance program is subject to these rules and regulations.  These regulations apply to Governmental or private agencies that participate in pr ogram administration.  These entities include the following:    Institutions;  Agencies;   Person(s) providing services; and   Providers of services.   The type of information includes, but is not limited to, the following:    The individual's Medicare beneficiary identifier ;  Facts regarding the individual's entitlement to health insurance benefits; and   Medical and other information obtained from CMS, a MAC (contractor).   Information not subject to these rules and regulations includes information in the provider's own records, such as the following:    Name;   Date of Birth;  Sex;  Marital status; and   Address.   A provider's own records are, however, subject to requirements listed in the "Conditions of Participation", that "Patient's records be kept confidential (20 CFR Pa rt 405.126).  These records may also be subject to State or local laws governing disclosure.   Providers are also responsible for following conditions for coverage.  A provider or supplier that receives a request for disclosure of information about a Medica re beneficiary, Medicare claim, or related information that it may not disclose, should refer the requestor to the appropriate contractor for further consideration of the request.  170.1 - Disclosure of Health Insurance Information to a Beneficiary or in Connection With a Claim  (Rev. 1, 09- 11-02)  Information such as Medicare entitlement or eligibility data may be disclosed to a beneficiary or their authorized representative (this includes the beneficiary's representative payee).   170.2 - Disclosure to Contractors (Rev. 1, 09- 11-02)  Providers and suppliers may not forward medical information to contractors on a confidential basis, expressed, or implied, since, under the Privacy Act, any medical information obtained by a contractor is subject to disclosure to the individual to whom the information pertains or to another person authorized by the individual to have access to it.  Some providers and suppliers document findings on medical forms pre -printed "confidential" or routinely stamp all records "confidential" whether or not such records are ever intended for disclosure to a contractor.  The contractor will accept such records only if the provider or supplier accompanies them with a signed statement indicating the following:    That the pr ovider or supplier understands the information is subject to disclosure to the patient under the Privacy Act, and    That any words or statements that the transmitted records are confidential may be disregarded if the patient or the patient's representative  requests them from the contractor or from CMS.   170.3 - Disclosure to Third parties for Proper Administration of the Health Insurance Program  (Rev. 1, 09- 11-02)  Disclosure by the provider or supplier to persons other than the individual or the individual's authorized representative of any records, reports, or other information about the individual is authorized without the individual's or their representative's consent under the following circumstances:   The disclosure is required in connection with any claim or other proceeding under the Social Security Act for the proper performance of the duties of:    Any officer or employee of the Department; or