by Christine Woolstenhulme, CPC, CMRS, QCC, QMCS
August 18th, 2022
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.
- CMS.Gov - CMS Discontinuing the Use of Certificates of Medical Necessity and Durable Medical Equipment Information Forms
- CMS Medicare Program Integrity Manual Chapter 5 – Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs)
- Noridian - Certificate of Medical Necessity (CMN) and DME Information Form (DIF)