Clearing up a CMN conundrum
Q. I thought that the manual chair CMN was eliminated along with the scooter and power wheelchair CMNs on Oct. 1, 2005, but I've heard otherwise. Please clarify.
A. When the national coverage determination (NCD) became effective for dates of service on or after May 5, 2005, the CMNs for mobility assistive equipment (manual chairs, power operated vehicles and power wheelchairs) were essentially rendered useless for medical necessity, as they did not reflect the new coverage criteria. Even though the CMNs were not changed to reflect the new coverage criteria, they remained in effect until Oct. 1, 2005. For claims received by the DMERC on or after Oct. 1, 2005, all CMNs for mobility assistive equipment--including manual chairs--no longer required the physician's signature, and therefore, were "officially" not used for justifying medical necessity, even though the CMNs were still required by the processing system.
Since the processing system could not be updated to pay claims for manual chairs, POVs and power wheelchairs until April 3, 2006, providers still had to submit these partially completed unsigned CMNs to the DMERC with provided generic information.
As of April 3, 2006, CMNs for manual chairs, POVs and power wheelchairs were no longer needed with the claims.
Since you no longer have a CMN to document the medical necessity for a manual chair you must obtain information from the patient's medical record. The medical record must prove that the patient cannot use a least costly alternative such as a cane or a walker to safely, and in a reasonable time frame, perform mobility related activities of daily living in his/her home.
Dan Fedor is general manager for education and compliance at Pride Mobility Products. Reach him at (800) 800-8586 or email@example.com.