e-CMN rules adrift in interpretation

INDIANAPOLIS, Ind. - Although Region B Medical Director Adrian Oleck has retracted the progressive e-CMN policy published in the DMERC's December supplier bulletin, leading some HME providers to say the e-CMN is now dead, CMS still says the DMERCs should accept e-CMNs. Based on information obtained from officials in the Program Integrity Office, which dictates policy on e-CMNs, a CMS spokesperson told HME News in June that e-CMNs, contrary to alarm bells now sounding in the DMEPOS supplier community, should be accepted. The confusion over the viability of the brightest tool to come out of CMS in recent years can be traced back to Medtrade Spring when Oleck heard that the other DMERCs had interpreted the September 2001 program memorandum, which opened the door to e-CMNs, differently. "They were interpreting [the September PM] to say that we still do have the right, at certain times, to request a hard copy signature in individual cases," said Oleck. After further communication with CMS, Oleck reversed the DMERC's progressive position on e-CMNs, effective Aug. 15, saying the DMERC would reserve the right to ask for a paper signature when there is a suspicion of fraud. The DMERC said "We may or may not request them (paper signatures), but if we do, you'd better have them," said Tim Pontius, an HME provider and chairman of the Region B Council, which meets regularly with Oleck. CMS, however, is saying the DMERCs should only ask for an original signature in "unusual circumstances." "If there is evidence that a CMN under review has been falsified, and the supplier is unable to supply adequate assurance of the medical necessity of the items or services, the DMERC can request original documentation, including the original signature," said the CMS spokesperson. A source at Trac Medical, who has been in touch with CMS's Program Integrity Office, said that even on post-payment audit and medical review, an e-CMN will suffice. And CMS told HME News that the DMERCs would rarely ask for a paper signature. The spokesman couldn't describe what kind of circumstances the DMERCs should construe as "unusual," and therein lies the rub. Unless providers are clear on what constitutes "unusual circumstances," many feel they'll still be obliged to get a CMN up front. "The reality of it is, that's the case," said Oleck. Yet to be decided is whether HME providers will be able to seek a paper signature retroactively. Oleck said his interpretation of current CMS policy would preclude that option. But he also allowed that more clarification on this issue from CMS could change his position. HME