evekhm/cms_iom_500 huggingface dataset:
(General Information, Eligibility, and Entitlement Manual)
Part A/Part B (A/B)/Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC) and the Single Testing Contractor (STC) Responsibilities for System Releases  40.1 -  Standardized Terminology f or Claims Processing Systems  40.1.1 -  Standard Terminology Chart  40.2 -  Release Software  40.2.1 -  Implementing Validated Workarounds for Shared System Claims Processing by Al l Medicare Contractors  40.3  Shared System Testing Requirements for Shared System Maintainers, Single Testing Contractor (STC)/Beta Testers, and Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare Administrative Contract ors (MACs) 40.3.1 -  Shared System Testing Requirements for Shared System Maintainers, Single Testing Contractor (STC), and DME MACs  40.3.2  Minimum Testing Standards for Shared System Maintainers and the Single Testing Contractor (STC)/Beta Tester  40.3.3 -  Testing Standards Applicable to all Beta Testers  40.3.4 -  Testing Requirements Applicable to the CWF Beta Tester  40.3.5  Part A/Part B (A/B) Durable Medical Equipment (DME) Medicare  Administrative Contractor (MAC) (User) and the Single Testing Contractor (STC) Testing Requirement s 40.3.6 -  Testing Requirements Applicable to all CWF Data Centers (Hosts)  40.3.7 -  Timeframe Requirements for all Testing Entities  40.3.8 -  Testing Documentation Requirements  40.3.9 -  Definitions  40.3.10 -  Test Case Specification Standard  40.3.11 -  Single Testing Contractor (STC) Non -Testable Conditions and Potential
(General Information, Eligibility, and Entitlement Manual)
Testing Impacts    40.3.12  Next Generation Desktop (NGD) Requi rements                                                                  50 - Contractor Implementation of Change Requests and Compliance with Technical Direction Letters  50.1 -  CR Implementation Report (CRI R) Template  50.2 -  TDL Compliance Report (TCR) Template  50.3 -  Sample Cover Letter/Attestation Statement 50.4 -  Change Request (CR) Definitions  50.4.1 -  Issue Date  50.4.2 -  Implementation Date  50.4.3 -  Effective Date  50.4.4 -  Date of Service  60 - Procedures for Modifying Shared System Edits and Capturing Audit Trail Data  60.1 -  CMS Standard File for Reason Codes  70 - Change Management Process (Electronic Change Information Management Portal)  80  Fee -For-Service Contractor Workload Transitions  80.1  Transition Handbooks  90 - IDR Claims Sourcing from Shared Systems   30 - Files Maintenance  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06-26-06)  30.10 - Files Maintenance Program - General  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Subject to the provisions of the Code of Federal Regulations, Title 41, Part 102 -  Creation, Maintenance and Use of Records, http://www.access.gpo.gov/nara/cfr/waisidx_05/41cfr102-193_05.html  CMS has the responsibility for the development and implementation of standards and programs for the econom ical management of records under the health insurance program.  Specifically, CMS is required to provide for effective controls over the creation of records, including the making of records containing adequate and proper documentation of the contractor's administration and operations.  Each contractor is required to establish and maintain an active, continuing program for the economical and efficient management of the records outlined in 30.20 .  The contractor's programs must provide for:    Effective controls over the creation, the organization, maintenance and use, and disposition of all CMS health insurance claims and non -claims records; and    Development and application of standards, procedures, and techniques designed to assure the maintenance and security of records of continuing value and facilitate the disposal of all records of temporary value.
(General Information, Eligibility, and Entitlement Manual)
 Development and application of standards, procedures, and techniques designed to assure the maintenance and security of records of continuing value and facilitate the disposal of all records of temporary value.   The contractor provides for the continued analysis and improvement of record classification and indexing systems, the use of filing equipment and supplies, and the reproduction and transportation of records.  The contractor assures that records are maintained economically and efficiently for maximum usefulness.   The files established by the contractor, and all records and procedures do cumenting its programs for controlling the creation, maintenance, and use of current records, for the selective retention of records of continuing value, and for the disposal of noncurrent records, must be available for periodic review by CMS.   Under no ci rcumstances are any records identified by CMS as relating to a current investigation or litigation/negotiation by the Office of the Inspector General or the Department of Justice, ongoing Workers Compensation, set aside arrangements, or documents which pr ompt suspicions of fraud and abuse of overutilization of services to be destroyed.  These records must be retained until you receive authorization from CMS.  30.10.1 - Description of Records Maintained  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Imple mentation: 06 -26-06)  A. Claims Records   These are Government records including Government -issued standard forms and other forms, documents, and statements needed to support claims.  Such records are maintained by the contractor in accordance with instruct ions regarding retention, transfer, destruction, and other disposition of claims materials.  (See 30.30 and 30.40 .)  B. Non -Claims Records   These include materials not needed as supporting documentati on of a claim, such as used work sheets, extra copies of documents, retained CMS bill copies where records were submitted on tape, used punched cards, EDP listings, used paper tape, and general correspondence not related to specific pending or processed cl aims.  See 30.30  for the records retention and disposal schedule and 30.70 for the disposition of such material.  C. Fiscal and Administrative Records   These include records that are not included as claims or non- claims records.  See 30.70  for the records retention and disposal schedule.   D. Microform Records
(General Information, Eligibility, and Entitlement Manual)
C. Fiscal and Administrative Records   These include records that are not included as claims or non- claims records.  See 30.70  for the records retention and disposal schedule.   D. Microform Records   This is a term used for any form containing micro -images (e.g., micro film, microfiche).  If records are microfilmed, the original records must still be retained.   E. Scanned/Imaged Records   This is a term used for any information that is recorded in a form that only a computer can process.  This is the preferred format when paper records are not retained.  The image becomes the official record/recordkeeping copy which must be retained in accordance with directives from CMS.   30.10.2 - Definition of a Record  (Rev. 38, Issued: 05- 26-06, Effective: 06- 26-06, Implementation: 06- 26-06)  Records are basically files consisting of papers, folders, photographs, photographic copies, magnetic tapes, or other recorded information regardless of physical form or characteristics, accumulated or maintained in filing equipment, boxes, disks , CDs or shelves, and occupying office or storage space.  Stocks of publications and blank forms are not included in this definition.  30.20 - Implementing a Files Management Program  (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.   Adequate records management controls over the creation of contract or files must insure that important policies and decision are adequately recorded, routine operational paper work is kept to a minimum, and the accumulation of unnecessary files is prevented.  Effective techniques in this area include the application of sy stems for the control of correspondence and forms, the minimizing of duplicate files, and the disposal without filing of transitory material that has no value for record purposes.
(General Information, Eligibility, and Entitlement Manual)
CMS expects each contractor to establish an appropriate program for the man agement of its files.  The following actions are generally basic to such a files management program.   A. Standardize classification and filing schemes to:   1. Achieve maximum uniformity and ease in maintaining and using program records;   2. Facilitate disposal of records in accordance with applicable records disposal schedules; and  3. Facilitate possible later consolidation of identical type files presently maintained at different locations.  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.
(General Information, Eligibility, and Entitlement Manual)
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.
(General Information, Eligibility, and Entitlement Manual)
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)
(General Information, Eligibility, and Entitlement Manual)
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)
(General Information, Eligibility, and Entitlement Manual)
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:
(General Information, Eligibility, and Entitlement Manual)
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
(General Information, Eligibility, and Entitlement Manual)
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)   These files consist of Requests for Payment and similar forms.  Also included are itemized bills, correspondence (including correspondence with district offices), and comparable documents used to support payment to beneficiaries, physicians, and other suppliers  of services under the Supplemental Medical Insurance (SMI) Program.   DISPOSITION:  Once the freeze is lifted, cutoff at the close of the CY in which paid.  Destroy 6 years and 3 months after cutoff.   2. Medicare Benefit Check Records (FROZEN - DO NOT DEST ROY)   These files consist of paid checks that contractors receive from banks covering amounts paid to providers of service, beneficiaries, physicians, and other suppliers of service under the Hospital Insurance and Supplementary Medical Insurance (SMI) pro grams.  Also included are check vouchers and cancelled or voided checks resulting from nonreceipt, loss, theft, or non- delivery.