Form-ing a Plan

If you have been following your updates, you will have noticed that a lot of changes are in the works at the DMERCs (soon to become Medicare Administrative Contractors).

New Certificates of Medical Necessity are being implemented, some old CMNs are being retired without a replacement, a new form that takes the place of the CMN — called the DME MAC Information Form (DIF) — is being implemented, and the 1500 form is going through a makeover (I am sure the software programmers would call it an “Extreme Makeover”).

The CMN changes go into effect Oct. 1, but there is a transition period in which you can use the old form until Dec. 31. As of Jan. 1, 2007, the old forms will no longer be accepted. During this period, it is imperative that you plan ahead properly to make the transitions as smooth as you can on your end.

The following old CMNs will be accepted during this transition period for claims with initial dates of service from Oct. 1 through Dec. 31:

• home oxygen therapy (the name changes to “oxygen” on the new CMN)
• hospital beds (the CMN will be eliminated)
• support surfaces (the CMN will be eliminated)
• lymphedema pumps (the name changes to “pneumatic compression devices” on the new CMN)
• osteogenesis stimulators
• transcutaneous electrical nerve stimulators (TENS)
• seat lift mechanisms
• external infusion pumps (requires a DIF as of Jan. 1, 2007)
• enteral and parenteral nutrition (although separate CMNs now, they will be combined into one DIF required as of Jan. 1, 2007)
• section C continuation form

The new 1500 form (version 08/05) goes into effect on Oct. 1 as well. (The old form will still be accepted until Feb. 1, 2007, assuming you are one of the few suppliers who are excluded from the mandatory electronic claims submission requirement.) At some point during the last quarter this year, you will need to make the switch. Proper planning will make this much easier and leave you with fewer headaches.

The first thing you will want to do is contact your software vendor and ask for a copy of their timeline for completing the capability to electronically submit all of the new CMNs. It is imperative your vendors also are ready early in the last quarter. You don’t want to wait until the last minute for them to be doing the conversion.

You also will need to know when you can start using the new 1500 form (version 08/05). Make sure you still will be able to print on the old version after Jan. 1, 2007, as well, since you are bound to have some insurers that are not ready to accept the new form on the transition date. You also should have a few of the old 1500s on hand just in case.

A comprehensive training process is absolutely necessary not only for your staff but also the physicians who refer to you. Your staff will need to be familiar with the new CMN and DIF forms as well as any new questions and signature requirements for each form. Note that all of the new CMNs and DIF form backs also have changed and are form-specific.

A letter to your physicians would be helpful so they are not hit with these new forms without some kind of a notice. You can direct them to the Medicare Learning Network (formerly Medlearn Matters) article MM4296 or to the following Web site, which actually has the new CMNs and DIF forms posted: www.cms.hhs.gov/Transmittals/downloads/R142PI.pdf. Since the PDF contains 57 pages, you may want to direct them to the sections that they need to look at.

Make a timeline for the things you need to get done related to the changes, and a checklist for each item on the timeline. Make sure each item is completed as close to the allotted time as possible. Once each item on your checklist is marked off, then you can be fairly sure you have done everything you can to make the form change transition as smooth as possible.

Also, realize that there are many factors beyond your control and there will most likely be some headaches associated with this transition. With good planning and a little luck, this will merely be a small bump in the road.

Jane Bunch is vice president, HME consulting, for Atlanta-based CareCentric. A reimbursement specialist, Bunch delivers educational seminars worldwide, helps develop corporate compliance plans and serves as a consultant for fraud and abuse cases. She can be reached at 678/264-4495 or via e-mail at [email protected].