Ask the DMERC MDs
CMS recently released instructions about the new CMNs and DMERC Information Forms (DIFs). In addition to providing the updated forms, transition instructions were provided. This month we'll discuss these documents.
CMNs provide a mechanism for the DMERCs to screen claims to see whether selected coverage criteria have been met.
First, the CMNs for power operated vehicles, manual and power wheelchair bases have been eliminated effective April 1, 2006. Since the transition for these is complete, we will not mention them further. We simply remind suppliers to discontinue all use of these forms for Medicare purposes. We are aware that other payers may still make use of these documents. Consult with them for further information.
For the remaining CMNs, numerous changes have been made. Some have been deleted while others have been changed into DIFs to allow the supplier to complete the form.
A DIF is completed and signed by the supplier. It does not require a narrative description of equipment and cost or a physician signature.
These new CMN and DIF forms are effective for claims with dates of service on or after Oct.1, 2006. The old forms are acceptable for dates of service up to and including Dec. 31, 2006. After Jan. 1, 2007, only the new forms are acceptable.
A few key points to remember:
- A supplier must have a faxed, photocopied or original signed order or an electronic CMN or DIF in their records before they can submit a claim for payment to Medicare. A faxed, photocopied or original signed order or an electronic signed CMN or DIF must be maintained by the supplier and available upon request.
- The CMN can serve as the physician's order if the narrative description in section C is sufficiently detailed.
- The supplier may not complete the information in section B of the CMN.
- Do not modify the language or content when reprinted. Also, do not accept any CMN or DIF that has been modified in any way by any other party.
- If there is a change made to any section of the CMN after the physician has signed the CMN, the physician must line through the correction and initial and date the correction or the supplier may choose to have the physician complete a new CMN.
- Cover letters can be used by a supplier as a method of communication between the supplier and the physician. Medicare does not require nor regulate the cover letter.
- It is the physician's and supplier's responsibility to determine the medical need for, and the utilization of, all healthcare services. The physician and supplier should ensure that information relating to the beneficiary's condition is correct.
Of note: CMS will maintain a medical review Web link that will house the "archived CMNs." It will keep the old CMNs on file. The link: http://www.cms.hhs.gov/MedicalReviewProcess/05_certificatesofmedicalnecc....
The PDF files for the new forms have not been uploaded yet. These new forms will not be available until the end of summer. The CMS forms page will keep the updated/new forms. The link for the new forms: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp#TopOfPage.
We will update the affected LCDs once the final files are available. Look for them to be posted by early September 2006.