Tuesday, December 31, 2002

CMNs and audits

Q. What are the regulations for a DMERC CMN in the event of a Medicare audit?

A: Medicare requires version .02 CMNs for all claims received on or after Aug. 1, 1996. When a CMN is submitted with a paper claim, the hard copy must be an exact reproduction of the CMS format.

CMS issued a memorandum stating the supplier may use an electronic CMN. It also stated that the CMN can be a fax or photocopy. However, CMS states in the program integrity manual and the DMERC advisories that if the carrier has any reason to believe the CMN has been altered or changed, the supplier could be requested to produce the original in the event of an audit. I believe at the present time the supplier is taking a business risk by not requiring the original CMN.

Section A should be completed by the supplier prior to being forwarded to the physician. Section B may be completed by the physician, or a clinician involved in the care of the patient.

Section C requires the narrative descriptions of the HCPC codes in section A, the supplier’s submitted charge and the Medicare fee schedule allowance.

Section D contains the physician’s attestation statement, the physician’s original handwritten signature and date. Suppliers billing electronically will answer the appropriate question on the electronic format. This information should be filed in the patient’s file.

Any changes, additions and/or corrections made to a DMERC CMN after the physician has signed and dated the form must be dated and initialed adjacent to the change.

Jeanie Lane is an independent consultant with The MED Group. Reach her at 601-372-5191.