What is a Certificate of Medical Necessity?

June 16, 2011 - PRLog -- What is a Certificate of Medical Necessity?
Introduction
Certificate of Medical Necessity (CMN) is a letter, usually a form, required by Medicare, other medical insurance companies, and even by medical equipment suppliers. It is a certificate authorizing the use of certain durable medical items and related equipment by a patient, and prescribed by a physician. CMN is also known by other names in some medical insurance companies and by medical equipment suppliers.
What is medical necessity?
Medical necessity is any services or supplies that are considered medically necessary if they are:
•   Not for the convenience of patient or physician
•    Meeting standards of good medical practice in the local medical community
•   Provided for diagnosis, direct care and treatment of medical condition
•   Appropriate and needed for diagnosis or treatment of medical condition
What does a CMN contain?
A CMN is like a detailed prescription which also discusses other information pertaining to a patient. A CMN addresses if the patient is suffering from severe hip or knee arthritis and serious neuromuscular diseases. The physician also addresses the physical capabilities of a patient, such as the ability to stand up and to move independently. If any medication, therapy or treatment has been used in the past to treat the condition, the physician needs to address the same along with details of improvements.
Who provides a CMN?
The letter or form is filled by a physician or physician’s employee, sometimes with the coordination of suppliers, to ensure correct and complete information is submitted to Medicare or other medical insurance companies or medical equipment suppliers.
What supplies need a CMN?
CMN is typically required for supplies like:
•   Wheelchairs, POVs (power operated vehicles), mobility scooters, scooters
•   Hospital beds, air-fluidized beds, seat lift mechanisms
•   Decubitus care cushions or mattresses
•   Oxygen, CPAP (Continuous Positive Airway Pressure) devices
•   External infusion pumps, lymphedema pumps or pneumatic compression devices
•   Osteogenesis stimulators (bone growth simulators), TENS (transcutaneous electronic nerve
•    stimulators)
•   Parenteral and enteral nutrition
What is the validity of a CMN?
A CMN needs to clearly specify all required supplies and services. Generally, a CMN is accompanied by a prescription. And the prescription needs to be for a valid date, not too long back from the purchase date, but within a reasonable time period. If the CMN is dated after the prescription date or after the purchase date, some insurance might disqualify a claim for reimbursement. If there is a significant change in the patient’s condition, then an updated CMN will be required.

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