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Departments |
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Certificate of Medical Necessity
(CMN)
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A "Certificate of Medical Necessity" (CMN) is a
document that many insurance companies,
including Medicare and Medicaid, require when a
physician is prescribing a costly item of
medical equipment.
Most health insurance programs will cover some
or all of the cost of necessary durable medical
equipment. Because this equipment is expensive,
and it is often needed for months, if not years,
insurance companies want to be sure that this
medical equipment is really necessary. It's not
unheard of for patients or their families to
want certain equipment more for convenience than
because they truly need it to treat or manage a
medical need. Insurance companies hate that.
Fully automatic hospital beds, special
mattresses for the treatment of pressure sores,
oxygen, certain wheelchairs, and seat lift
mechanisms are some of the more familiar items
that will require a CMN before Medicare,
Medicaid and many other insurance companies will
approve payment.
The Certificate of Medical Necessity is usually
prepared by the durable medical equipment
provider who will be delivering the item to the
patient. The document is forwarded to the
physician for signature, and the equipment
company coordinates submitting the necessary
information to Medicare (for sake of this
discussion we'll use "Medicare" as our example
insurance company).
There must be clinical information in the
doctor's chart to support the need for each
particular piece of equipment ordered. The
doctor may not be required to submit this
additional information, but it must be there
just in case.
Without a Certificate of Medical Necessity,
Medicare will not cover the cost of equipment
requiring a CMN. It is, therefore, very
important to verify that the medical equipment
company has the required authorization before
you take delivery. If Medicare has not
authorized coverage you could end up with a very
expensive bill for equipment rental.
The CMN is not something that a caregiver or
patient should have to "mess" with. There are
times, though, when CMN paperwork can disappear
on a doctor's desk. If your medical equipment
supplier says they have submitted the documents
to the doctor and are having trouble getting it
signed, you may have to get involved. The most
productive thing you can do is ask your supplier
for a copy of the Certificate and hand carry it
to the doctor. Either say you will wait until
the doctor has signed the CMN or, if that will
be a futile endeavor, say you will return the
next day to pick it up in person. If the doctor
is in the office, his staff may help move things
along just to get you out of their waiting room.
Don't attempt to find the appropriate CMN
document for your specific need on the Internet.
While you may find something that looks correct,
you won't be able to tell whether it's the one
currently in use. They are revised from time to
time. Your durable medical equipment provider
will always have the most recent, correct
version and will know how to complete it
correctly. You should never attempt to fill out
these documents yourself. Errors will simply
result in rejection. Leave it to your DME
company. They know how to complete these
documents correctly.In case you're curious,
here's an
example of a Medicare Certificate of Medical
Necessity form. It's reduced in size so you
won't even be tempted to try to use it!
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