Information That the Contractor May Disclose

160.1 - Information That 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 for 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 §160ff 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 information 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 facility, 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. Processing 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 Supplement 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 contractor refers the request to the RO.