‘Headache’ will go away for more than just oxygen 

WATERLOO, Iowa – Much of the celebration around the elimination of the certificate of medical necessity (CMN) requirement on Jan. 1, 2023, has focused on oxygen concentrators, but four other product categories will also benefit from the change. 

Seat lift mechanisms, TENS devices, pneumatic compression devices and osteogenesis stimulators will all no longer require CMNs starting next year. 

“It’s a big deal,” said Ronda Buhrmester, senior director of payer relations and reimbursement for VGM & Associates. “It’s always a challenge to get the physician to sign and return CMNs, so this will take out an extra headache.” 

Additionally, CMS has decided to drop the DME Information Form (DIF) requirement for external infusion pumps, and enteral and parenteral nutrition. 

The elimination of the CMN requirement will also speed up payment, a blessing in an environment where overhead expenses are high, Buhrmester says. 

“Getting a claim submitted quicker and getting paid quicker is more important these days,” she said. 

Plus, it wasn’t uncommon, Buhrmester says, for the CMNs not to follow policy. That sometimes meant, for example, that a patient would meet the coverage criteria in the policy but the provider would have to answer no to several questions on the CMN. 

“The provider would just know they’d get a denial and have to go through the appeals process,” she said. 

The days of the CMN have been numbered, Buhrmester says. It used to be a “golden ticket” to having a claim paid, but it’s the medical record that now plays the larger role in determining medical necessity, she says. 

“The CMN used to hold more weight, but that changed over the course of the years, especially as audits amped up,” she said. “When the program integrity manual pointed out that the CMN, by itself, was not enough to prove medical necessity, that was the tipping point.”