CMS memo clarifies e-CMN position

Saturday, November 30, 2002

WASHINGTON - Boosters of the e-CMN are hailing a Sept. 27 CMS transmittal as all the clarification necessary for e-CMNs to pass muster at any of the DMERCs.

Published by CMS's Program Integrity office, the transmittal clarifies two points: 1) The DMERCs "must" accept e-CMNs; 2) if there is a suspicion of fraud, and the DMERC launches an investigation, it will be the supplier's responsibility to prove the authenticity/validity of the signature on the CMN.

"This should put to rest anyone's reservation about using electronic CMNs," said Cara Bachenheimer, a healthcare attorney at Epstein Becker & Green in Alexandria, Va. "If I were an attorney representing somebody under investigation, I would much rather have a client using electronic CMNs than paper CMNs because it's a lot easier for me to prove it's an authentic document electronically than it is to prove the authenticity of paper and pen."

Not everyone is as buoyant. Some insiders say reservations are still worth maintaining since CMS has yet to sanction any specific standard or technology to authenticate CMNs. But critics of that point of view wonder to what standards an auditor might cling to distinguish whether the white-out on a CMN came from the doctor's office or the HMEs?

E-CMN boosters believed the CMS program memorandum published in September 2001 definitively opened the door to the e-CMN. But there was a lingering question at DMERCs whose directors believed they still had the right, when reviewing or investigating an HME, to request a paper signature.

In July, Region B Medical Director Adrian Oleck told HME News he believed HME providers were still obliged to get a paper CMN up front. 'The reality of it is, that's the case," he said then.

Oleck was not available for comment for this article. But Robert Hoover, M.D. medical director for Region D, said whether to accept or not accept e-CMNs has been clear for some time in his region. Already in Region D, American HomePatient has begun collecting CMNs from doctors electronically at select locations.

"In my mind, it's been pretty clear from directives from CMS that these are forms of documents that under routine circumstances we will accept," said Hoover. "I think they've just manualized some of those instructions."

Bachenheimer said this transmittal should make it clear that the DMERCs cannot request a paper signature from suppliers using e-CMNs. "The issue now is that whatever CMN type you use, if there's an allegation of fraud, it will be the supplier's responsibility to prove the authenticity," said Bachenheimer.

The technology that providers are so far leaning on to process e-CMNs - Trac Medical's and eClickMD - as far as Hoover can see, is pretty good.

" I think it gives us at least as much assurance as we have on a traditional CMN," he said. HME