Provider Statistical and Reimbursement System

The PS&R system is comprised of 4 applications: PS&R, System for Tracking and Audit and Reimbursement (STAR), Medicare Cost Report E-Filing system (MCREF), and Visor.  STAR, MCREF, and Visor are PS&R subsystems and for the purposes of this document “PS&R” refers to the entire system (including STAR, MCREF, and Visor), except where explicitly stated.

The PS&R System is used by Part A/B Medicare Administrative Contractors (A/B MACs) to accumulate the statistical and reimbursement data applicable to the Medicare claims processed.  It summarizes these data on reports that are used by medical providers and A/B MACs to complete key elements of the Medicare Cost Report (MCR).  PS&R data are subsequently used by the A/B MACs to reconcile MCRs. PS&R permits the A/B MACs and providers to utilize the system produced reports to accumulate statistical and payment data for hospitals, hospital complexes, skilled nursing homes, and home health agencies.

The Provider Statistical and Reimbursement (PS&R) System also provides functionality that allows providers to submit MCRs and supporting documentation to CMS electronically through a subsystem of PS&R known as the Medicare Cost Report E-Filing system (MCREF). Providers submit their MCR and all supporting documentation through the MCREF webpage and the MCR is parsed for relevant data and stored in the System for Tracking Audit and Reimbursement (STAR) database. The MCR is also stored in a file repository within MCREF for long term storage.

The CMS Visor subsystem allows authorized users to view dashboards, visualizations, and reports related to PS&R/STAR data. Visor consists of a web-based, java front end and Tableau data visualizations.

The PS&R System receives all Medicare Part A claims after they are finalized and paid by the CMS Part A Claims processing system, Fiscal Intermediary Standard System (FISS). FISS sends PS&R the paid claims and PS&R loads the claims into its system, performs additional payment calculations, and assigns the claims and the claims’ line items to the appropriate PS&R report types. PS&R receives/tracks all user report request parameters. PS&R also tracks Part A provider information entered by MAC users (e.g., provider number, address, facility names, Periodic Interim Payments (PIP) status, bankruptcy status, servicing MACs, relationships with home offices, relationships with other providers, certification dates, decertification dates, change of ownership dates, change of MAC dates, etc.), part A provider annual cost report information (e.g., cost report reminder letters, cost report past due letters, cost report acceptance dates, tentative settlement dates, desk review / audit dates, cost report data, appeals data, reopening data, wage index dates, Tax Equity and Fiscal Responsibility Act (TEFRA) dates, provider based determination dates, interim rate review dates and types, etc.), change log information (i.e., stores before/after data for a changes made by users and identifies which user made the change and when), and report request.

The two categories of PS&R users are general users and web service users. PS&R system users consist of CMS users, MAC users, and providers who are authenticated using the Identity Management system (IDM) authentication server. PS&R web service users are authenticated using the Extensible Markup Language (XML) Gateway. User identifiers are assigned by IDM.

PS&R regularly uses PII to retrieve system records including Medicare Health Insurance Claim Numbers (HICN) User id, Medicare Beneficiary Identifier (MBI), Social Security Number (SSN) about Patients, Name, date of birth, email, phone numbers, mailing address, medical record number, financial information, providers, medical interns/residents, and Medicare Administrative Contractors (MACs).

PS&R retains records in compliance with Bucket 3 of the CMS Records Schedule. The disposition for these records is a minimum of 7 years and the Bucket allows for longer retention based on Agency business needs.

PS&R is a Medicare Part A claims reporting system and a system for tracking Part A provider annual cost report reimbursement, review, and audit.  The system contains Medicare part A claims which are sent to PS&R from the FISS, as well as Medicare Cost Report (MCR) data that is submitted by MACs into STAR, and MCR data submitted by providers via MCREF. Providers use claim reports from PS&R to create their Medicare Part A cost report each year, and CMS and MACs track these cost reports through the audit and reimbursement process.

PS&R regularly uses PII to retrieve system records including Medicare Health Insurance Claim Numbers (HICN) User id, Medicare Beneficiary Identifier (MBI), Social Security Number (SSN) about Patients, Name, date of birth, email, phone numbers, mailing address, medical record number, financial information, providers, medical interns/residents, and Medicare Administrative Contractors (MACs).

• Social Security Number
• Name
• E-Mail Address
• Phone Numbers
• Date of Birth
• Mailing Address
• Medical Records Number
• Financial Account Info
• Other - Medicare Health Insurance Claim Numbers (HICN)User ID, Medicare Beneficiary Identifier (MBI)

• Patients
• Other - Providers, medical interns/residents, and Medicare Administrative Contractors (MACs), and CMS employees

• Within the OPDIV

• Members of the Public

• Within HHS

Users accept the terms and conditions specified in the System Use Notification before they are authenticated in CMS IDM. The user approved these terms and conditions when they registered their user ID in the CMS authentication system. These users voluntarily provided their personal information to receive user IDs and access to CMS applications.

The PS&R system does not collect PII directly from individuals. The information is present on the paid claims record, the format of which is specified by another CMS system.  PII is collected by these other systems where they are responsible for notifying individuals whose information are being collected.

• Users: Claim auditors (CMS and MACs) require information on the claim including SSN to audit Medicare reimbursement. Only CMS and MAC administrative users have access to PII. These users can run the reports without PII if they need to share their reports with other CMS or MAC users.

  CMS, MAC, and Provider user's login to PS&R and request reports on the loaded claims; these requests are conducted by the user entering the report parameters he/she is interested in – e.g., Provider number, report type, claim service dates, claim paid dates, report format, etc.

• Administrators: CMS and MAC administrative users have access to PII. They can run the reports without PII if they need to share their reports with other CMS or MAC users.
• Developers: PS&R developer users have access to PII data for troubleshooting production issues.
• Contractors: PS&R direct contractor users (MACs and system maintainer users) have access to PII data. PS&R system maintainer users have access to PII data for troubleshooting production issues. MAC users can run the reports without PII if they need to share their reports with other CMS or MAC users.

Each user of the PS&R system is trained on how to use the system and are briefed on their responsibilities to the system. Employees are also provided with yearly security training. 

CMS is required to provide role-based Information Security (IS) training to employees and contractors who have specialized roles within CMS' Information Security (IS) program. CMS users are required to complete computer-based training (CBT) courses regarding information security and privacy awareness before receiving access to the CMS network and as part of the annual recertification process.

The PS&R System Maintainer team members are required to complete corporate information security training when hired and annually thereafter. CGI's CMS account training coordinator tracks training activities and attendance.

PII within PS&R is housed in the production environment and governed by its record retention policy. Data in PS&R is managed using Bucket 3 of the CMS Records Schedule. The disposition for these records is a minimum of 7 years and the Bucket allows for longer retention based on Agency business needs.

Records Schedule Number: DAA-0440-2015-0004