Re: Medicare CMNs

Re: Medicare CMNs

Jim Price

9/13/2003

Original question:
Dear list, are CMNs a requirement for medicare billing?

We obtain CMNs on every Medicare patient. I have not found any
information, however, in Medicare's manual stating this necessity.
DMERC states only the necessity of a detailed Rx prior to billing.
And yes, I have contacted AOPA. They are always good at
responding.eventually.


The following information was taken from the Region C Supplier Manual,
however, the information in the supplier manuals is adopted from the from
the Medicare Coverage Issues Manual and pertains to all regions.

CMNs per se are not required for O & P.
(Section 6.3 Region C DMEPOS Supplier Manual [Summer 2001]).
A detailed order is not required before billing.
Some DME items require a detailed written order before delivery. There are
no O & P codes on this DME list.
(Section 6.2 Region C DMEPOS Supplier Manual, [Summer 2001]).
An initial order is required before service is provided.
(Section 6.1 Region C DMEPOS Supplier Manual, [Summer 2001).
The initial order can be verbal, by telephone, fax, traditional Rx, etc.
(Section 6.1 Region C DMEPOS Supplier Manual, [Summer 2001]).
The initial order must contain (a) patient's name, (b) brief description
of device, (c) date, and (d) physician's name.
(Section 6.1 Region C DMEPOS Supplier Manual, [Summer 2001]).
A detailed written order must be included in the patient's file (no
reference to before service or billing).
(Section 6.1 Region C DMEPOS Supplier Manual, [Summer 2001]).
The detailed written order must contain the following:
1. Patient's name;
2. A description of the item ( the description can be either a narrative or
a brand name/model number) and the length of need;
3. Quantity, frequency of change or use, and length of need;
4. Not applicable to O & P (pertains to drugs)
5. Patient's diagnosis;
6. Start date of order;
7. Physician's signature and date.
(Section 6.1 Region C DMEPOS Supplier Manual, [Summer 2001]).
There is no exclusion for O & P from completing the detailed order before
the physician signs.

Other items of interest regarding O & P coverage:

1. Separation of DME from O & P (Code of Federal Regulations Part 414
Section 414.202; Omnibus Budget Reconciliation Act of 1990 [OBRA 1990,
Section 4153]; Section 5 Region C DMERC Supplier Manual, July 1994).

2. Brace Benefit Category (Section 53.5 Region C DMEPOS Supplier Manual,
Spring 2002).

3. Patient responsibility... (Section 1879, Social Security Act).

4. Information about the patient's condition may not reside in physician
office records...(Section 1833, Social Security Act; Section 6.3 Region C
DMEPOS Supplier Manual, Summer 2001).

Want to win appeals and influence Administrative Law Judges? Know these
basics!

Jim Price, Ph.D., C.P.O.
.