Form-ing a Plan

If you have been following your updates, you will have noticed that a lot of changes are in the works at the DMERCs (soon to become Medicare Administrative Contractors).

New Certificates of Medical Necessity are being implemented, some old CMNs are being retired without a replacement, a new form that takes the place of the CMN — called the DME MAC Information Form (DIF) — is being implemented, and the 1500 form is going through a makeover (I am sure the software programmers would call it an “Extreme Makeover”).

The CMN changes go into effect Oct. 1, but there is a transition period in which you can use the old form until Dec. 31. As of Jan. 1, 2007, the old forms will no longer be accepted. During this period, it is imperative that you plan ahead properly to make the transitions as smooth as you can on your end.

The following old CMNs will be accepted during this transition period for claims with initial dates of service from Oct. 1 through Dec. 31:

• home oxygen therapy (the name changes to “oxygen” on the new CMN)

• hospital beds (the CMN will be eliminated)

• support surfaces (the CMN will be eliminated)

• lymphedema pumps (the name changes to “pneumatic compression devices” on the new CMN)

• osteogenesis stimulators

• transcutaneous electrical nerve stimulators (TENS)

• seat lift mechanisms

• external infusion pumps (requires a DIF as of Jan. 1, 2007)

• enteral and parenteral nutrition (although separate CMNs now, they will be combined into one DIF required as of Jan. 1, 2007)

• section C continuation form

The new 1500 form (version 08/05) goes into effect on Oct. 1 as well. (The old form will still be accepted until Feb. 1, 2007, assuming you are one of the few suppliers who are excluded from the mandatory electronic claims submission requirement.) At some point during the last quarter this year, you will need to make the switch. Proper planning will make this much easier and leave you with fewer headaches.

The first thing you will want to do is contact your software vendor and ask for a copy of their timeline for completing the capability to electronically submit all of the new CMNs. It is imperative your vendors also are ready early in the last quarter. You don't want to wait until the last minute for them to be doing the conversion.