If you are a provider, supplier, biller, or vendor who bills durable medical equipment (DME) Medicare Administrative Contractors (MACs) for services and supplies you provide to Medicare patients, there is a change coming in the new year. Beginning Jan. 1, 2023, the Centers for Medicare and Medicaid Services (CMS) is discontinuing Certificates of Medical Necessity (CMNs) and DME Information Forms (DIFs).
Originally, CMN and DIF forms were required to help document medical necessity and other coverage criteria for selected DME. Currently, suppliers are required to get a signed CMN from the treating physician or a created and signed DIF to submit with the claim. However, improvements in claims processing and medical record management over the years now ensures that the information submitted in these forms can be found either on the claim or in the medical record, making CMN and DIF forms redundant.
In an effort to modernize processes and reduce burden on the system, CMS has decided that submitting CMN and DIF forms is no longer needed.
Avoid Claim Rejections
Make sure your providers and billing staff know the following rules to avoid claim rejections:
For services provided on or after Jan. 1, 2023: Don’t submit CMN or DIF forms or their electronic claim data elements with claims or they will be rejected and returned.
The forms that shall be eliminated are as follows:
484 – Oxygen
846 – Pneumatic Compression Devices
847 – Osteogenesis Stimulators
848 – Transcutaneous Electrical Nerve Stimulators
849 – Seat Lift Mechanisms
854 – Section C Continuation Form
10125 – External Infusion Pumps
10126 – Enteral and Parenteral Nutrition
For services provided before Jan. 1, 2023: Submit CMN and DIF forms or their electronic claim data elements with claims if required. Continue to follow this process for any services rendered through Dec. 31, 2022 (if a claim requires a CMN or DIF form, you must send it with the claim or have it on file from a previous claim).