No paper: doc signs first e-CMN

LINCOLN, Neb. — The long-anticipated era of the e-CMN dawned here Aug. 21 when an American HomePatient billing clerk opened a completed certificate of medical necessity digitally signed by Dr. John Trapp, a physician partner at Pulmonary Specialties. AHP and Pulmonary Specialties have been beta testing Trac Medical's CareCert e-CMN system for months, but Trapp's Aug. 21 signature marked the first time a home medical equipment provider has filed an e-CMN without paper backup. The pioneering move by AHP comes amid lingering confusion over the DMERC's position on e-CMNs. Although CMS published a Program Memorandum that opened the door to e-CMNs in Sept. 2001, Medicare's administrators have yet to provide a clear message to the DMERCs about how to handle e-CMNs. In the Region B DMERC, Medical Director Adrian Oleck said his interpretation of the Sept. 2001 memo allows the DMERC to ask for a paper CMN on audit. (See HME News, July 15, 2002). In Region D, however, the supplier manual published in April 2002 makes an allowance for e-CMNs. Trac Medical says it's on certain ground in Lincoln, which is in Region D. On a Medicare audit, said Trac Medical CEO Jeff Frankel, the CareCert e-CMN is completely bullet-proof. "The DMERC can see the chronolog, which is the trail of creation," he said. "They can view the physician's credentials, and they can also view the authentidation, its digitial DNA, as well as time and date information. If upon audit, if that has changed, you would know someone has manipulated the content." In July, Trac Medical signed its first revenue-generating contract with American HomePatient. Executives at both firms estimate revenues for Trac Medical could be as much as $350,000 by the end of the second year if all the regional centers use the new system to process CMNs and physicians' orders. The windfall for American HomePatient, the nation's fourth largest provider of respiratory and home medical equipment, is harder to quantify right now. But the company fully expects to see its own gains in short order. "There is no doubt that we will see a positive payback in terms of efficiency," says Doug Gouy, vice president of reimbursement for American HomePatient. "Our tests showed that CareCert can reduce the time needed to complete medical forms by as much as two-thirds while improving our billing and collections cycle." HME