Washington Providers having trouble getting custom-made home medical equipment to their patients could run into reimbursement snags, according to new guidelines for certificates of medical necessity adopted by all four Durable Medical Equipment Regional Carriers. The new rule calls for equipment to be delivered to a Medicare beneficiary within three months of the CMN's completion and signing, or it requires a new CMN, officials said.

"If too much time passes from the time a CMN is completed by the physician and the item is delivered to the beneficiary, the item may no longer be medically necessary or appropriate because of changes in the beneficiary's medical condition," says Region D DMERC in its notice. If more than three months elapse, the DMERC adds, "a new CMN will have to be completed and signed before claim submission for reimbursement from the DMERC."

***The new res raised few hackles. "I don't see it as a problem with us, not yet anyway," said Rosemary Francisco, president of Diamond Medical, Little Rock, Ark. Her company fills equipment orders well within the three-month time frame, she said.

But it could present difficulties for those ordering custom equipment or for those providing rehab, Francisco pointed out. "I can see it being a problem for specialty equipment-if you had quadriplegic or paraplegic patients who had to have chairs specially made and geared toward their individual needs. But other than that, I don't see where it would be a problem."-J.P.P.