CMNs and DIFs=Rocket science?


Are certificates of medical necessity (CMNs) and DME information forms (DIFs) that confusing to fill out and submit?

The Hills Have Eyes dvd 2 Days in Paris download I hope so, considering Noridian Administrative Services just published a bulletin that states claims denied due to issues with CMNs and DIFs represent 35% of the appeals workload in Jurisdiction D.

What's up with that?

The claims denials and resulting appeals aren’t cheap, either. The denials cost Medicare, on average, $1.4 million for just one year. An appeal costs providers, on average, $36.74.

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That's a lot in a world where every penny counts.

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As part of the bulletin, Noridian offered tips to ensure claims aren't denied due to CMN and DIF issues. Things like submit the forms with initial claims, and make sure all necessary information is present on the forms.

That doesn't seem like rocket science to me.

Liz Beaulieu

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Well for some physicians and their staff it would seem a very likely assumption that to complete the CMNs and DIFs is "rocket science". Most cannot fill out the oxygen form the first time correctly, that is even after having just recently (last week) filled out three. It would be interesting to see from what time span the resulting 35% is from. As the first of the year proved to make it impossible for the medicare side of things to accept a new CMN for the oxygen claims. They all rejected and had to be adjudicated manually. So on the provider side they were submitted, just not accepted. And Education is best resolution on all fronts to take care of this issue, and with face to face workshops being very limited and many other factors it is not a suprise that there are issues arising.

It is rocket science to physicians and their staff. About 60% of our CMNs come back to our DME missing information and has to be resubmitted to them for completion. In many cases, it has to be resubmitted over and over until it is complete. The phsyician's think the DME's are the ones requiring this information and that we "are being tough" on them. Training for completing CMNs are needed especially since the office staff at these doctors offices is a high turnover position.

CMS claims to educate our physicians but I seriously doubt it because I haven't found many physiican offices that can complete a simple physicians order. What about all these physicians that have been exempted from having to go through accrediation? I guess they don't have to follow the same standards as HMEs do. It is a shame because if they had to be accredited, they might be forced to read the educatonal materials CMS puts out.