Stakeholders have concerns with CMS’s plans for CMN

WASHINGTON – CMS’s plan to discontinue CMNs on Jan. 1, 2023, may cause problems for HME providers trying to comply with a new national coverage determination for home oxygen therapy that went into effect Sept. 27, say industry stakeholders.  

Following the release of the NCD, CMS issued change requests to push new language to the decision manual and to trigger claims processing edits to align with the new guidelines, but nothing related to eliminating the CMN for oxygen specifically. Then on May 5, the agency published an MLNConnects article saying it would discontinue all CMNs, as well as the DME information forms (DIFs), at the start of next year.  

“We had an increasing suspicion that the department within CMS investigating the CMN issue would tackle CMN elimination with a future date that’s not pegged to Sept. 27, which would be problematic on numerous fronts,” said Andrea Stark, a Medicare consultant and reimbursement specialist for MiraVista.  

If the implementation dates aren’t in line, claims will deny inconsistent with the NCD. For example, the updated NCD eliminated the chronic stable state requirement but question 2 on the 484 CMN still asks if a patient is in a chronic stable state. A “no” answer will trigger denial of services.  

Stark suspects that in drafting the language for the change request on the elimination of the CMN, CMS encountered a number of complexities in the claims process that didn’t have immediate solutions, but she believes “this is a solvable problem.”  

“We’ve provided ideas to CMS on this,” she said. “The MACs are already processing claims successfully without the CMN using the CR modifier and COVID narrative. It’s not that it can’t be done; it is actively being done.”  

CMS, which has given the DME MACs until June 14 to comply with the NCD and ensure claims aren’t denied inconsistent with the NCD, said in the article that it will provide additional information soon.  

“The MACs have told us they need additional direction from CMS,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “We’ve had conversations with CMS, and they’ve listened to our concerns and said to sit tight.”