decisionhealth Newsletters, Answer Books - 2008 Issue 12 (December)
Answer_Book / Certificates_of_Medical_Necessity / CERTIFICATES_OF_MEDICAL_NECESSITY
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Article Overview
This article explains Medicare certificate-of-medical-necessity requirements as they relate to durable medical equipment. It covers the kinds of equipment involved, the documentation process, what physicians and suppliers may each complete, timing for responding to requests for more evidence, and the role of Medicare and DMERC forms. It is relevant to physicians, suppliers, and billing staff working with DME claims.
Why This Topic Matters
Understanding these documentation requirements helps providers and suppliers recognize when extra paperwork is needed and what elements Medicare expects before payment can be made for certain DME claims.
What You Will Learn
- Which categories of durable medical equipment are associated with certificate-of-medical-necessity requirements
- What types of documentation may support medical necessity
- How physician and supplier responsibilities are divided on the form
- What happens when additional evidence is requested
- How Medicare and DMERC forms relate to the CMN process
Who Should Read This
- Physicians
- Durable medical equipment suppliers
- Medical billing staff
- Coding and reimbursement professionals
Codes Discussed
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