Home Forums Discussions General Discussion Medicare CMN (certificate of medical necessity)

Anyone aware of a change in medicare regulations regarding CMNs? All of a sudden I am being requested to provide my last progress note when I order a wheelchair or similar for a patient. One national DME supplier told me that was to prevent fraud and to make sure patients are actually being seen and not just getting an order for a piece of equipment. I personally and professionally have a problem disclosing all of my patient's medical issues (or at least the ones documented on the note) just to get a piece of equipment. The correct diagnosis codes are on there for that equipment (i.e. hemiparesis). I was wondering what others thought.

(At this point I am probably just going to generate a letter stating the relevant diagnosis and the date of the most recent encounter.)

I am now getting this for wheelchairs, but also for electronic blood glucose meter supplies. I think it is ridiculous and wonder if it is a law or just another invasion by mail order companies. My personal belief is that mail order strip companies are nothing but a rip off of our medical care system.

The whole CMN thing is friggin' B.S., pardon my "French."
I am getting more of this type crap lastely.
I have the same reservations as you both about sending the whole problem list.

I get these all the time and throw the more ridiculous ones away. For diabetic supplies I complete only the pertinent parts of the form. When they ask what the patient's last HgBA1C was I tell them it is none of their business. Then at the patient's next office visit I strongly urge them to dump these suppliers and buy locally. I recently had a popular supplier (who uses an overweight, grizzly, moustached spokesman) send me a form saying one of their clients was requesting a heating pad and an erectile dysfunction device. I called the patient and asked if he had indeed requested these and he confirmed that he did not. He vehemently said he does not need the ED device and, when the Statue of ....... rep said he could get a heating pad free he said (naturally) ok. When I filled him in on the shady tactics he declined both and I tore up the papers.
I also refuse to reveal to insurance companies any specific information about a patient's labs, compliance issues, etc. My feeling is that is between the patient and their insurance. If the patient wants to divulge this then let them. But, I also stress to patients that they do not HAVE to (at least not yet). Nor do they have to talk to the insurance companies' "nurses" when they call and try to give them medical advice.

Leslie

Another thing that ticks me off (Adam, you have me ranting today) is when an insurance drug plan sends me a form saying the patient would like to consider changing to a generic because it would save blah blah blah.....
I fax my answer back that I will not respond to this request unless the patient initiates it, meaning the patient must contact me first to discuss whether this is an appropriate consideration.

Here's another (ok, the last one today). A number of the local pharmacies fax their prescription refill requests on forms which have lengthy advertising, such as how many gazillion $4 generics they have. I fax them back that I will not respond to their requests until they remove their advertising which is not only falling on deaf ears but which is highly unprofessional and inappropriate.

Ok, ok, I hear all of you saying to yourselves, "No wonder Leslie is in solo practice!!" But, in my defense, I have been successful at it for many years while I see group after group tumbling around me.

Leslie

You go girl!!
I'm right there with you Leslie.
I do some of the same stuff you do.

The only way these problems EVER change is if we unionize as a profession. Maybe it'll happen someday.

An outside possibility is that change will occur from the patient/consumer side, but they won't give a sh*t unless it starts affecting them and their wallet (maybe the time is very close at hand).

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