Ch-Ch-Ch-Ch-Changes

With so many changes scheduled for our industry in 2006 and 2007, it is vital that we truly understand them and know how we are going to implement each of them into our businesses.

Since the hospital bed Certificate of Medical Necessity and the Group III CMN will be eliminated on Oct. 1, it is important that you obtain the documentation to prove medical necessity per the CMS policy for both. Read each policy carefully and make sure you implement a Physician Order for each that will ask questions to determine if the patient qualifies before this equipment is delivered. It is much easier to know what is required when we have CMNs than it will be when CMNs are eliminated.

Other CMN modifications that take effect Oct. 1 will change what you have become accustomed to when receiving these CMNs back from the treating physician. Since they have become somewhat familiar with the old CMNs, you will need to set up educational sessions with your referring physicians to teach them what the changes are and how this affects the coverage of items for Medicare beneficiaries — and for those insurance company patients who follow Medicare guidelines.

Make an educational book including the Medicare policies and CMN changes to hand out. Also, take the time to educate your staff about these changes. Make the same educational materials available for your employees, and make tests to give them to verify that they understand the changes.

CMN changes are as follows for lymphedema pumps and oxygen:

• Lymphedema pumps are now called “pneumatic compression devices,” and the CMN changes from a DMERC 04.03B to a MAC 04.04B form.

  Questions 4 and 5 on the old CMN have been eliminated, and two questions have been added to the new CMN. Question 2 on the new CMN asks, “If the patient has venous stasis ulcers, have you seen the patient regularly over the past six months and treated the ulcers with a compression bandage system or compression garment?” Question 5 on the new CMN asks, “Has the patient had lymphedema since childhood or adolescence?”

  To make things even more confusing, Question 1 on the new CMN was Question 3 on the old CMN; Question 3 on the new CMN was Question 2 on the old CMN; and Question 4 on the new CMN was Question 1 on the old CMN. In Section A, recert has been added; the supplier's National Provider Identifier number or Legacy number is requested; and the physician's NPI or UPIN number is required. It is now a CMS-846 (09/05) form.