CMS Pub. 100-01, ch. 6, § 200

Contractors (A/B MACS (A and B), A/B MACs (HHH) and DME MACs) shall stop

printing the Medicare Number on reimbursement checks to Medicare beneficiaries.

Reimbursement checks going to Medicare beneficiaries are subject to others (e.g. banks)

seeing the Medicare Number. CMS has determined that there is no business reason for

the Medicare Number to be printed on the reimbursement check to the beneficiary.

Therefore, CMS is directing Medicare contractors to stop printing the Medicare Number

on reimbursement checks to Medicare beneficiaries.

This change in policy does not affect the use of the Medicare Number by Medicare

contractors. The Medicare program uses the Medicare Number to meet administrative

responsibilities to pay for health care and to operate the Medicare program. In

performance of these duties, Medicare is required to protect individual privacy and

confidentiality in accordance with applicable laws, including the Privacy Act of 1974 and

the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996

(HIPAA).

Exhibit A - Freedom of Information Act Request

Exhibit B - Summary Sheet for the CMS Monthly FOIA Report

MAC/CENTRAL OFFICE COMPONENT SUMMARY SHEET FOR THE CMS

MONTHLY FOIA REPORTS

Data on this Summary Sheet is a summation of the data from all Forms CMS-632-FOI

completed during the month.

INSTRUCTIONS

1. Enter the month and year that this summary sheet covers.

2. Enter, in the applicable space, appropriate identifying information concerning

your unit.

3. Enter the total number of 632s completed during the identified month.

4. Enter the number of times the 632s showed a request was closed by the cited

action.

5. Enter the total of all staff hours used during the identified month. Use only whole

numbers and fractions or decimals, e.g., 102 1/2 or 102.25, not 102 hours and

fifteen minutes.

6. Enter the total of actual cost figures, based on the salaries of the staff involved.

7. Enter the total of copying charges.

8. Enter the mailing/postage costs.

9. Enter the total dollar amount of fees charged. This figure is not the same as actual

costs.

10. Enter the total of all fees waived. (Unless the FOI Office, CMS has granted a

waiver, this figure is a compilation of all fees which were waived because they

were lower than CMS' $15.00 threshold).

11. Enter the name, office and address of the person who completed this summary

sheet.

12. Enter the date the summary sheet was completed.

PLEASE FILL OUT COMPLETELY

1. Month: ________________ Year: __________

MAC: __________________________________________________

CENTRAL OFFICE COMPONENT:

_____________________________________________

Total 632s: _________________

Actions:

___________ Direct Reply

(Records Sent) _____________ No Records Found

___________ Request Withdrawn _____________ Not FOIA

___________ Records Not

Reasonably Described _____________ Subpoena Denial

___________ Fee Related Closure _____________ Other

Staff Hours: ___________

Staff Charges: ____________

Copy Charges: ____________

Postage: ____________

Fees Charged: ____________

Fees Waived: ____________

Name/Phone: ____________________________________________

Office: _________________________________________________

Address: ________________________________________________

Date: __________

Exhibit C - Invoice of Fees for FOIA Services

Exhibit E - “Medicare Authorization to Disclose Personal Health

Information” form and “Information to Help You Fill Out the Medicare

Authorization to Disclose Personal Health Information Form”