Medicare request gets mixed reviews

Friday, September 30, 2005

WASHINGTON - A request by CMS to the Office of Management and Budget could mean the end of some CMNs.
Earlier this year, Medicare submitted recommendations to the OMB to eliminate or change several CMNs in major products categories, including hospital beds, infusion pumps, and enteral and parenteral nutrition. At press time, the OMB had not ruled on this request.
"Medicare met with industry groups and came up with these changes," said Lisa Smith, an attorney with Brown & Fortunato. "There may be some minor tweaks, but there is really no reason to believe that OMB won't approve the changes. After that, Medicare will start to implement those changes."
According to an entry in the Federal Register, CMS has proposed eliminating CMNs for both parenteral and enteral nutrition, and combining them on a single DMERC Information Form. The CMN for infusion pumps would also be replaced by a DIF.
Most notably, these changes would eliminate the need for suppliers to get a physician's signature on their claim forms.
James Wiley, owner of Option One Billing Solutions, which coordinates billing for 3,000 enteral patients, said the new regulation, if approved, would greatly ease a provider's paperwork burden.
"It would make things tremendously easier," said Wiley. "It doesn't matter if it's enteral therapy or oxygen - you are moving away from a document that physicians have to fill out very specifically and answer questions to qualify patients. It would be a great thing."
Others expressed concern that the change could open the product line up to fraud and abuse problems.
"It's kind of like letting the fox in the hen house, in my opinion," said Bruce Brothis, president of Chandler, Ariz.-based Alternative Billing Solutions.
"One parenteral patient can have an average monthly claim between $12,000 and $15,000, and with all the fraud and abuse and belt tightening I can't understand why now they are going to let these suppliers sign their own claims."
Other changes waiting approval include the elimination of CMN forms for hospital beds and support surfaces.