Implementing a Files Management Program

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 contractor 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 systems 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. CMS expects each contractor to establish an appropriate program for the management 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 users 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 requests 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 for advance payment or at time of receipt of billing form; and other considerations.