by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Aug 18th, 2022
Updated Article - REMINDER!
This is important news for durable medical suppliers! Effective January 1, 2023, CMS is discontinuing the use of Certificates of Medical Necessity (CMNs) and DME information forms (DIFs). We knew this was coming as the MLN sent out an article on May 23, 2022, but it is time to make sure your staff knows about these changes.
CMS stated in the MLN SE22002 CR 12734, Elimination of Certificates of Medical Necessity & Durable Medical Equipment Information Forms
• For services on or after January 1, 2023: Don’t submit CMN or DIF forms or their electronic claim data elements with the claims or we’ll reject your claims and return them to you
• For services before January 1, 2023: Submit CMN and DIF forms or their electronic claim data elements with the claims if required
Original release Date May 23, 2022 MLN SE22002:
Attention providers, suppliers, billers, and vendors who bill Durable Medical Equipment (DME) to Medicare! Currently, a Certificate of Medical Necessity (CMN) is documentation from the treating physician indicating the item is medically necessary; it is valid for up to three months after the signature and date on the form which is used as the start date. CMNs contain sections A through D. Sections A and C are completed by the supplier, and Sections B and D are completed by the physician. A DIF is then completed and signed by the supplier. It does not require the cost, a narrative description of the equipment, or a physician's signature.
However, this is about to change. If you are familiar with these forms and instructions for filling out a certificate, this news will make your day as CMNs and DIFs are very time-consuming. CMS states, "Due to improvements in claims processing and medical records management, the information found on CMNs or DIFs is available either on the claim or in the medical record and is redundant." This will certainly reduce unnecessary administrative burdens on clinicians, DME suppliers, and beneficiaries, which is desperately needed.
CMS is discontinuing the use of certificates of medical necessity (CMNs) and durable medical equipment (DME) information forms (DIFs) for claims with dates of service on or after January 1, 2023. Prior to January 1, 2023, the forms are still required.
This is not just a suggestion; CMS states, “We’ll not accept CMNs and DIFs on claims for dates of service on or after January 1, 2023. If we get a claim with a date of service on or after January 1, 2023, we’ll reject the claim and return it to you.”
You no longer need to complete these forms for claims with dates of service on or after January 1, 2023:
• CMS-484 – Oxygen
• CMS-846 – Pneumatic Compression Devices
• CMS-847 – Osteogenesis Stimulators
• CMS-848 – Transcutaneous Electrical Nerve Stimulators
• CMS-849 – Seat Lift Mechanisms
• CMS-854 – Section C Continuation Form
• CMS-10125 – External Infusion Pumps
For current rules from CMS on DME, including orders, documentation, face-to-face encounters, medical necessity, and much more, be sure to review the Medicare Program Integrity Manual Chapter 5. Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items and Services Having Special DME Review Considerations.
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.