Tag: Certificate of Medical Necessity

WATERLOO, Iowa – Much of the celebration around the elimination of the certificate of medical necessity (CMN) requirement on Jan. 1, 2023, has focused on oxygen concentrators, but four other product categories will also benefit from the change.  Seat lift mechanisms, TENS devices, pneumatic compression devices and osteogenesis stimulators will all no longer require CMNs starting next year.  “It’s a big deal,” said Ronda Buhrmester, senior director of payer...

WASHINGTON – CMS has posted a joint DME MAC publication clarifying that certificates of medical necessity are not required for oxygen claims during the public health emergency.  The publication also clarifies that DME Information Forms are not required for external infusion pumps during the PHE.  “CMS-1744-IFC (an interim final rule issued April 6, 2020) stated that CMS would exercise enforcement discretion for clinical indications of coverage for the oxygen NCDs...

WASHINGTON – CMS’s plan to discontinue CMNs on Jan. 1, 2023, may cause problems for HME providers trying to comply with a new national coverage determination for home oxygen therapy that went into effect Sept. 27, say industry stakeholders.   Following the release of the NCD, CMS issued change requests to push new language to the decision manual and to trigger claims processing edits to align with the new guidelines, but nothing related to eliminating the CMN for oxygen specifically....

YARMOUTH, Maine – Outdated, redundant and confusing is the common refrain from HME Newspoll respondents who overwhelmingly support CMS’s decision to eliminate the CMN requirement for home oxygen therapy.  “The CMN is an outdated tool that simply seems to supply Medicare with another means to deny claims on technicalities,” wrote Josh Turner, billing manager at McAbee Medical in Decatur, Ala. “Everything on the CMN is in the medical record, so there is no reason...

WASHINGTON – The Council for Quality Respiratory Care in a statement today encouraged CMS to reconsider eliminating the CMN for home oxygen therapy.  The CQRC, a coalition of the nation’s largest respiratory providers and manufacturers, says doing that would replace “objective testing ordered by a patient’s physician for the subjective decision-making of Medicare contractors.”  “We are highly supportive of allowing acute patients to receive oxygen...

WASHINGTON – The Council for Quality Respiratory Care in a statement today encouraged CMS to reconsider eliminating the CMN for home oxygen therapy. The CQRC, a coalition of the nation’s largest respiratory providers and manufacturers, says doing that would replace “objective testing ordered by a patient’s physician for the subjective decision-making of Medicare contractors.” “We are highly supportive of allowing acute patients to receive oxygen therapy outside...

WASHINGTON – CMS’s proposed national coverage determination for home oxygen therapy – its first revision since 1993 – makes “groundbreaking” changes, including expanding access for acute conditions and removing the CMN requirement.  Industry stakeholders say the agency is proposing the changes largely as a result of the COVID-19 pandemic, which significantly increased the number of people needing oxygen and exposed issues with the current NCD.  “We...