evekhm/cms_iom_500 huggingface dataset:
(General Information, Eligibility, and Entitlement Manual)
30.40.3 - Retention Period - Microfilmed Material  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  MACs who have been authorized to microfilm claims records (see 50ff) may be permitted to transfer an accumulation of the original source documents to an approved offsite storage facility, after retaining for a shorter period than is outlined in 30.40 -  30.40.2.  Accumulation Period  Retention Period Transfer  a. 1/1/06 -  1/31/06  1 month 3/1/06 b. 6/1/06 -  6/30/06  1 month 8/1/06  30.50 - Microfilming of Files Material  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Some MACs have been authorized to microfilm  claims records and other files material; e.g., computer printouts, cancelled checks, financial records.  Due to the document freeze, these contractors are not authorized to destroy original source documents but are permitted to transfer an accumulation of  these documents to an offsite storage facility after microfilming and verification of the quality and completeness of the film.  (See  30.30.2 , item 3, concerning destruction the hard copy Medicare Summary Notices after microfi lming.)  The accumulation period may be daily, weekly, or monthly, depending on volume.  Generally, contractors should not make shipments of less than three cartons.  They coordinate transfer procedures with the storage facility.   In 30.90 , Exhibits 6- 12 contain various sample forms to be used by contractors when microfilming files material.  These forms are not supplied by CMS.  Reproduction of the forms is the responsibility of the contractor.   30.50.1 - Microfilming Procedures  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  A - General
(General Information, Eligibility, and Entitlement Manual)
30.50.1 - Microfilming Procedures  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  A - General   The contractor must authenticate each roll of film containing reproductions of Medicare claims records by including certificates of authenticity at the start and at t he end of the filmed documents. (Material other than claims records need not be authenticated.)  The contractor produces these certificates and target cards as needed, using the language contained in the examples in 80, Exhibits 6 -12.  The camera operator completes a report for each roll that is microfilmed.  See Exhibit 12 , for an example of a roll report.  The contractor films claims records without attachments (e.g., coding sheets) overlaying data on the re cord.  If data on the attachment is needed for reference purpose, the contractor films it separately.   To ensure that the camera is working efficiently when files material is being microfilmed, the contractor films a microcopy resolution test chart on the first roll in the morning and the first roll in the afternoon.  It gives these rolls priority processing so that any camera malfunction is discovered as soon as possible. Exhibit 11  provides an example of a resolution test chart tha t cannot be used for actual tests.  Usable charts are available from microfilm suppliers.   B - Normal Filming   The contractor films the start certificate (see Exhibit 5)  after any target (or flash) cards that identify or index the documents on the film and before the records are filmed.  It files the end certificate (Exhibit 6)  after the last document and before any end target card.  It retains documents in the order they were filmed for ease in reviewing the pr ocessed microfilm.   The following is an example of normal filming sequence:   OUT  START     OF  FILM  LEADER  <ABOUT -2 FEET  ROLL  NUMBER  CARD   TITLE  CARD  FILING SEQUENCE CARD  START CERTIFICATION  OF AUTHENTICITY CARD  TEST*  CHART   \ / \ / \   DOCUMENT    DOCUMENT    DOCUMENT   LAST  DOCUMENT  LAST  CERTIFICATE  OF AUTHENTICITY CARD  \ / \ / \  / \ / \  END  CARD           TRAILER ABOUT  2 FEET  *Filmed Twice Each Day  END OF FILM  / \ / \ / \  C - Corrections   If the camera operator notices that a document has been incorrectly filmed due to being twisted, folded, or torn, photograph a correction card (see Exhibit 7)  right after the incorrect document.   The following is an example of correc tion filming sequence:
(General Information, Eligibility, and Entitlement Manual)
The following is an example of correc tion filming sequence:   \ / \ / \  DOCUMENT   DOCUMENT  (TORN)   CORRECTION  CARD   DOCUMENT  (REPAIRED)   DOCUMENT   / \ / \  D - Filming Retakes and Additions   When the processed microfilm roll is reviewed, some documents may be illegible or incorrectly photographed.  Other documents may have been out of file or omitted at the time of the original microfilming.  The contractor will re -photograph these documents a nd splice onto the front of the completed microfilm roll.  If splicing is not practical, it will maintain the retakes and additions as a separate microfilm roll.  It will photograph a start of retake or addition card (Exhibit 8)  imme diately before the documents to be rephotographed or added.  Photograph an end of retake or addition certificate (Exhibit 9)  immediately after the last document to be rephotographed.  The following is an example of retake or addition filming sequence:   \ / \ / \  START RE-TAKE OR ADDITION CARD   DOCUMENT   DOCUMENT   DOCUMENT   END OF ADDITION OR RETAKE CERTIFICATE  \ / \ / \  30.50.2 - Microfilming Index Label  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Affix an index label to each contents of the roll microfilm and provide reference markers.  It lists the normal filming and the retakes and additions.   Below is an example of an index label:   Title:    Roll No. CMS -1453   CONTENTS INDEX    Index Point 1  CMS-1453  Control Number        00400     Through   00450   Index Point 2  CMS -1453  Control Number        00451      Through   00499   Index Point 3  Retakes  00427, 00451, 00478   Index Point 4  Additions  00429, 00446, 00463 END OF ROLL  End of Roll   30.50.3 - Retention and Destruction of Microfilm  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  A - Master Microfilm
(General Information, Eligibility, and Entitlement Manual)
30.50.3 - Retention and Destruction of Microfilm  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  A - Master Microfilm   After producing the number of copies of the microfilm required for reference purposes, the contractor retains the ma ster microfilm as a security file.  It stores it at an offsite location so that copies may be made in the event the reference copies are destroyed.  It disposes of the master microfilm at the time the storage facility disposes of the hardcopy contained on the film.  (See 30.30  for records disposition instructions.)   (The contractor need not maintain a master microfilm security file of records such as computer printouts when complete computerized backup data is retained.  It dispos es of the master microfilm when there is no longer a need to produce reference copies of the microfilm.)   B - Copies of Microfilm   The contractor retains one copy of the microfilm as a reference copy to be kept on site for use when needed.  It disposes of this copy with the master microfilm.  (See subsection A above.)   The contractor may dispose of any other reference copies of the microfilm 2 years after the end of the calendar year in which the documents were filmed.  These copies may be retained for a longer period if they are needed for reference purposes but not longer than the master microfilm.   C - Destruction of Microfilm   The contractor should destroy microfilm by shredding as this method provides the most complete destruction of the data on the fil m.  Other methods of destroying film, e.g., exposure to extreme heat or boiling, do not eradicate the data as completely or efficiently.  Shredders exist that can destroy both film and reels.  The contractor should retain cartridges or magazines which contained the microfilm for reuse because of the high cost of replacement.   If a contractor does not have a shredder and purchase of a shredder is not cost justified, it should check local sources such as microfilm equipment vendors, microfilm service bureaus, banks, and insurance companies for a shredder that it can use to destroy its film.  If a shredder cannot be located, the contractor should contact its regional office for assistance.
(General Information, Eligibility, and Entitlement Manual)
30.60 - Annual Report of Medicare Records (Rev. 38, Issued: 05- 26-06, Effective: 06 -26-06, Implementation: 06- 26-06)  The Centers for Medicare & Medicaid Services (CMS) conducts a reporting of total records on hand in current file rooms, offices, and offsite storage facilities.  Since Medicare claims records and related reco rds created and maintained by you must be included, you must prepare an Annual Report of Medicare Records (See Exhibit 13) .  Each contractor shall prepare this report every year as of September 15, regardless of your fiscal year end ing date, and mail one copy to reach the address shown below no later than September 30: Centers for Medicare & Medicaid Services  Records Officer, OSORA/IRMG  Mail Stop, SL -12-16 7500 Security Boulevard  Baltimore, MD  21244- 1850  30.70 - Disposition of Non -Claims Materials  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Non-claims materials, as defined in 30.10.1B , may be disposed of by the contractor.  Retained CMS bill copies ( where records were submitted on tape) may be destroyed.   In disposing of this material, the contractor must:    Ensure the confidentiality of information regarding a particular beneficiary, provider, physician, or supplier by protective shredding, mutilation, or contractual provisions with the subcontractor regarding similar protective measures.    Provide for offsetting expenditures with salvage value received when contractual relationships have been established with a local contractor for the sale of non- claims materials for its salvage value.  In such cases, the contractor records the salvage value received, and offsets the initial expense of purchasing such materials by such value received.   30.80 - Standards for All Records Storage Facilities  (Rev. 38, Issued: 05 -26-06, Effective: 06- 26-06, Implementation: 06- 26-06)
(General Information, Eligibility, and Entitlement Manual)
30.80 - Standards for All Records Storage Facilities  (Rev. 38, Issued: 05 -26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  A facility that is used to store Federal records, must meet the minimum structural, environmental, property and life safety standards as outlined in 36 CFR 1228.228- Facility Requirements http://www.access.gpo.gov/nara/cfr/waisidx_05/36cfr1228_05.html  by October 1, 2009.  You must submit a Facility Standards for Record Storage Facilities Inspection Checklist (see E xhibit 14) for all storage facilities used to house CMS records to the CMS Records Officer.   The facility must be constructed with non- combustible materials and building elements, including walls, columns and floors.  You may request a waiver of this requi rement from the National Archives and Records Administration through CMS for an existing records facility with combustible building elements to continue to operate until October 1, 2009.  Your request must provide documentation that the facility has a fire  suppression system specifically designed to mitigate this hazard and that the system meets the requirements in 36 CFR 1228.230--Fire Safety Requirements http://www.access.gpo. gov/nara/cfr/waisidx_05/36cfr1228_05.html .  Requests for waivers must be submitted to your CMS Regional Office contact who will forward to the CMS Records Officer for final approval by the National Archives and Records Administration.   30.90 - Exhibits  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)
(General Information, Eligibility, and Entitlement Manual)
30.90 - Exhibits  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Exhibit 1.  Preprinted Container Label  Exhibit 2.  Minimum Label Data Required for Unlabeled Boxes  Exhibit 3.  Records Transmittal and Receipt -  Standard Form 135 Exhibit 4.  Reference Request -  Federal Records Center -  Optional Form 11 Exhibit 5.  Certificate of Authenticity - Start  Exhibit 6.  Certificate of Authenticity - End Exhibit 7.  Correction Card  Exhibit 8.  Start of Retake or Addition Certificate  Exhibit 9.  Retake o r Addition Certification  Exhibit 10.  Resolution Test Chart  Exhibit 11.  Witness Disposal Certification (Sample)  Exhibit 12.  Roll Report  Exhibit 13  Report of Medicare Records  Exhibit 14  Inspection Checklist -- Standards for Record Storage Facilities  Exhibit 1 - Preprinted Container Label  (Rev.124, Issued: 05- 17-19, Effective: 06- 18-19, Implementation: 06- 18-19  ACCESSION NO.      CARTON NO.    of  AGENCY    MAJOR SUBDIVISION   DESCRIPTION OF RECORDS (BRIEF)    Instructions for Completing Label   Accession No.  - Control number you assign to each shipment of records.   Carton No. -  Show the box number and also the total number of boxes in the same shipment, e.g., 5 of 60.   Agency -  Enter CMS   Major Subdivision -  Enter the name of the MAC in this block.  Descri ption of Records -  Enter Part A A/B MAC (A) or (HHH) or Part B A/B MAC (B) or DME MAC -  Medicare bills and related claims records received, processed and paid (including dates), or Part A A/B MAC (A) or (HHH) - Medicare Fiscal Records, canceled checks and related records (including dates).   Also, for each box, show the inclusive  claims numbers , dates, etc., depending on arrangement of records.   Exhibit 2 - Minimum Label Data Required for Unlabeled Boxes  (Rev. 124, Issued: 05- 17-19, Effective: 06- 18-19, Implementation: 06 -18-19  For boxes not having a preprinted label (see Exhibit 1 above), enter the label as shown:   CARTON   _____   OF  ______  CARTONS   CMS   MAC NAME   CITY, STATE   MAC -  PAID MEDICARE BILLS   DATE TO DATE
(General Information, Eligibility, and Entitlement Manual)
CARTON   _____   OF  ______  CARTONS   CMS   MAC NAME   CITY, STATE   MAC -  PAID MEDICARE BILLS   DATE TO DATE   (086- 12-8462A --093-14-2362T)   Instructions For Labeling Boxes   Use broad -point felt tip marker to facilitate shelf reference.   Minimum Label Data   Accession Number  - Control number assigned to each shipment of records.   Carton No. -  Show the box number and also total boxes in the shipment, e.g., 5 of 60.   Agency -  Show "CMS."   Office - Show the name of MAC with city and State address.  Description of Records -  For Medicare bills and related records, show:  "MAC name -  Paid Medicare Bills (inclusive dates)."  For fiscal records, can celed checks, and related records, show: " MAC -  Medicare Fiscal Records (inclusive dates)."   First and Last Entry in Box  - Show the inclusive claim number, terminal digit numbers, check numbers, or other designated key numbers.   Exhibit 3 - Records Trans mittal and Receipt - Standard Form 135  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Click on the link below then scroll down and click on Records Transmittal and Receipt Form -  SF135.   http://www.archives.gov/records_center_program/forms/sf_135_intro.html   Exhibit 4 - Reference Request - Federal Records Center - Optional Form 11  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementati on: 06- 26-06)  Click on the link below to access Optional Form 11  http://www.gsa.gov/forms   Exhibit 5 - Certificate of Authenticity - START  (Rev. 124, Issued: 05- 17-19, Effective: 06- 18-19, Implementation: 06- 18-19
(General Information, Eligibility, and Entitlement Manual)
http://www.gsa.gov/forms   Exhibit 5 - Certificate of Authenticity - START  (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 Medi care 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.    CONTRACTOR NAME AND ADDRESS    CERTIFICATE OF AUTHENTICITY    START   THIS IS TO CERTIFY THAT THE MICROPHOTOGRAPHIC IMAGES APPEARING ON THIS ROLL OF MICROFILM:   STARTING WITH (e.g., control number, Medicare beneficiary identifier )  ARE ACCURATE REPRODUCTIONS OF THE RECORDS OF:   AND WERE MICROFILMED IN THE REGULAR COURSE OF BUSINE SS PURSUANT TO ESTABLISHED ROUTINE COMPANY POLICY FOR SYSTEMS UTILIZATION AND OR FOR THE MAINTENANCE AND PRESERVATION OF SUCH RECORDS THROUGH THE STORAGE OF SUCH MICROFILMS IN PROTECTED LOCATIONS.   IT IS FURTHER CERTIFIED THAT THE PHOTOGRAPHIC PROCESSES US ED FOR MICROFILMING OF THE ABOVE RECORDS WERE ACCOMPLISHED IN A MANNER AND ON MICROFILM THAT MEETS THE RECOMMENDED REQUIREMENTS OF THE NATIONAL BUREAU OF STANDARDS FOR PERMANENT MICROPHOTOGRAPHIC REPRODUCTIONS.   Date Microfilmed      Camera Operator   Locati on      Authorized Signature   Exhibit 6 - Certificate of Authenticity - END (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)   CONTRACTOR NAME AND ADDRESS    CERTIFICATE OF AUTHENTICITY    END   THIS IS TO CERTIFY THAT THE MICROPHOTOGRAPHIC IMAGES APPEARING ON THIS ROLL OF MICROFILM:   ENDING WITH   ARE ACCURATE REPRODUCTIONS OF THE RECORDS OF:   AND WERE MICROFILMED IN THE REGULAR COURSE OF BUSINESS PURSUANT TO ESTABLISHED ROUTINE COMPANY POLICY FOR SYSTEMS UTILIZATION AND OR FOR THE MAINTENANCE AND PRESERVATION OF SUCH RECORDS THROUGH THE STORAGE OF SUCH MICROFILMS IN PROTECTED LOCATIONS.   IT IS FURTHER CERTIFIED THAT THE PHOTOGRAPHIC PROCESSES USED FOR MICROFILMING OF THE ABOVE RECORDS WERE ACCOMPLISHED IN A MANNER AND ON MIC ROFILM THAT MEETS THE RECOMMENDED REQUIREMENTS OF THE NATIONAL BUREAU OF STANDARDS FOR PERMANENT MICROPHOTOGRAPHIC REPRODUCTIONS.   Date Microfilmed       Camera Operator   Location       Authorized Signature
(General Information, Eligibility, and Entitlement Manual)
Date Microfilmed       Camera Operator   Location       Authorized Signature   Exhibit 7 - Correction Card  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  CORRECTION CARD   CORRECTION  THIS DOCUMENT  HAS BEEN REPHOTOGRAPHED  TO ASSURE LEGIBILITY    Exhibit 8 - Start of Retake or Addition Certificate  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06 -26-06)  RETAKE OR ADDITION CARD START OF RETAKE OR ADDITION   The images appearing between this point and the "End of Retake or Addition" are true copies of records, which were missing or provide unsatisfactory on inspection of the origin al microfilm reel.   For a description of rephotographed material, see operator's "Retake or Addition Certificate" at the end of this section.    Exhibit 9 - Retake or Addition Certificate  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  CONTRACTOR NAME AND ADDRESS   CERTIFICATE OF AUTHENTICITY   RETAKES OR ADDITIONS   THIS IS TO CERTIFY THAT THE MICROPHOTOGRAPHIC IMAGES APPEARING ON THIS ROLL OF MICROFILM:  ENDING WITH   ARE ACCURATE REPRODUCTIONS OF THE RECORDS OF:   AND WERE MICROFILMED IN THE REGULAR COURSE OF BUSINESS PURSUANT TO ESTABLISHED ROUTINE COMPANY POLICY FOR SYSTEMS UTILIZATION AND OR FOR THE MAINTENANCE AND PRESERVATION OF SUCH RECORDS THROUGH THE STORAGE OF SUCH MICROFILMS IN PROTECTED LOCATIONS.   IT IS FURTHER C ERTIFIED THAT THE PHOTOGRAPHIC PROCESSES USED FOR MICROFILMING OF THE ABOVE RECORDS WERE ACCOMPLISHED IN A MANNER AND ON MICROFILM THAT MEETS THE RECOMMENDED REQUIREMENTS OF THE NATIONAL BUREAU OF STANDARDS FOR PERMANENT MICROPHOTOGRAPHIC REPRODUCTIONS.   Date Microfilmed      Camera Operator   Location      Authorized Signature   Exhibit 10 - Resolution Test Chart  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  The resolution test chart can also be viewed at the following link:   http://www.efg2.com/Lab/ImageProcessing/TestTargets/#Microcopy      Exhibit 11 - Witness Disposal Certification (Sample)  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06 -26-06)
(General Information, Eligibility, and Entitlement Manual)
Exhibit 11 - Witness Disposal Certification (Sample)  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06 -26-06)  WITNESSED DISPOSAL CERTIFICATION  Disposal Date:   _____________________ Medicare Contractor:  ________________________________________ Address:    ________________________________________     ________________________________________ Disposal Location:  ________________________________________ _____________________________________________________________
(General Information, Eligibility, and Entitlement Manual)
Volume by Cubic Feet (e.g., number of boxes):  ____________________ Description & Year(s) of Records Destroyed: _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ I certify that I witnessed th e proper destruction of CMS Medicare records approved for disposal on the date and location named in this document. Print Name:  __________________________________ Title:    __________________________________ Signature:   __________________________________ Date:   ________________ Exhibit 12 - Roll Report  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  ROLL REPORT     CAMERA NO.       LIGHT LEVEL       IRIS      REDUCTION
(General Information, Eligibility, and Entitlement Manual)
ROLL REPORT     CAMERA NO.       LIGHT LEVEL       IRIS      REDUCTION        PROCESSING DEPARTMENT  DATE PROC.       DEV. TIME       CHEM. TEMP       REMARKS       PROCESSOR       INSPECTION DEPARTMENT  APPROVED  RESHOOTS       FOOTAGE       INSPEC.  TIME      INSPECTORS  INTIALS      DENSITY        RESHOOTS WILL BE FOUND ON       THIS ROLL FOR ROLL NUMBERS    THEIR ROLL       NO.  AGENCY       NAME  OUR ORDER       NUMBER   FILMING TIME       LUNCH       TIME  BREAK       TIME  PREP      TIME WAITING       TIME SET-UP      TIME TRAVEL      TIME REMARKS        OPERATORS INITIALS       Exhibit 13  Report of Medicare Records  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  ANNUAL REPORT OF MEDICARE RECORDS   Name & Address of Medicare Contractor      Name, Title and Phone # of the Person Submitting the Report     Type of Medicare Contractor (Carrier/Intermediary/DMERC, etc.)       Current File Room   Offsite Storage   Storage Costs  1. Total Records on Hand at the End of the Reporting Period       a. Magnetic Tape Included in Line 1       b. Microfilm Included in Line 1       c. CDs included in Line 1      d. Paper included in Line 1        2. Records Transferred to Storage During Reporting Period (provide the number of boxes)       a. To Offsite Storage Included in Line 2   $   b. To Onsite Storage Included in Line 2   $ TOTAL STORAGE COSTS (Add 2a+b)    $     3. Total Records in Offsite Storage During the Contract Period      For the purpose of this report, volume may be calculated according to the following table of cubic foot equivalents:   1 record storage box1 cubic foot  Letter -size filing cabinet.1 cubic feet per drawer  Legal -size filing cabinet..2 cubic feet per drawer  Magnetic Tape.1 cubic foot  per 7 reels  Microfilm.1 cubic foot per 108 rolls  CDs.. cubic foot per 12 case holder   Exhibit 14 - Inspection Checklist - Facility Standards for Records Storage Facilities (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implement ation: 06- 26-06)