Monday, February 28, 2005

The CMN’s future
with Asela Cuervo
A. Cuervo

Q. In January, CMS requested comments on CMN changes submitted to the Office of Management and Budget (OMB) for Paperwork Reduction Act (PRA) review. What changes might we expect?

A. Over the last several years, PRA reviews for CMNs had become routine. There have been few changes in their format or the questions on the forms. The PRA review focused mostly on CMS’ justification for the CMNs and the supplier community’s assessment of the relative burdens of completing CMNs. In the January notice, CMS announced some significant changes to the CMNs under review. CMS proposes to streamline the oxygen CMN and eliminate the CMNs for hospital beds and support surfaces. In addition, the CMNs for external infusion pumps, enteral and parenteral nutrition have been replaced with DMERC Information Forms, or “DIFs” that are signed by the supplier.

In its supporting statement, CMS states that the “new CMNs capture the current approach to determining coverage and encourage thoughtful consideration of all treatments and dialogue between physicians, beneficiaries and suppliers . . .” Although CMS does not provide details on its “current approach” to determining coverage, it is clear that these changes reveal a shift in the role of the CMN in documenting medical necessity. The changes suggest that CMS and the DMERCs will continue to require medical necessity documentation from sources other than the CMN to support claims for DME. Clearly, the supplier community will need to continue to press for guidance from CMS and the DMERCs on what constitutes sufficient documentation of medical necessity.

Asela Cuervo is the principal in the Law Offices of Asela Cuervo in Washington, DC. 202-496-1281.