[Regina]

At the recent seminar I attended, we were told that the CMN must be completed by the physician who wrote the prescription. However, as I'm sure many of you experience, we often get patients discharged from the hosital, and when we send the CMN to the ordering physician he refers us to the patient's pulmonologist or primary.
In the region A LCD it only states,

A Certificate of Medical Necessity (CMN) which has been completed, signed, and dated by the treating physician must be kept on file by the supplier and made available upon request. The CMN may act as a substitute for a written order if it is sufficiently detailed.

Tht refers to the treating physician, not the ordering physician. How does everyone handle this? It really puts us in the middle, as usual.

[Sleeping410]

Medicare has always said the CMN must be completed by the "Treating" physician. I have always considered the hospitalist as giving a "verbal" order for the O2 and had the treating physician complete a detailed Rx and the CMN. He does however use the test performed at the hospital as his test results. Hope that helps!

[Regina]

You are very wise. I think I am jsut so frustrated with all this Medicare bull that I can't think straight!

[twiedemer]

We get the ordering Physician to complete the CMN's. Our PCP's won't as they didn't order the equipment.

[Sleeping410]

"For certain items or services billed to a DME MAC, you must receive a signed CMN from the treating physician. You must have a faxed, photocopied, original signed order or an electronic CMN in your records before you can submit a claim for payment to Medicare. CMNs and DIFs are referred to by their CMS form numbers. The CMS form number is located in the bottom left corner of the form. DME MAC form numbers identify the CMN on electronic claims submitted to the DME MAC. "


The Treating Physician is the physician who is responsible for the continuing care of the patient. The hospitalist should only complete the CMN if they are continuing to care for the patient for the condtion being treated by the equipment on the CMN.

[brr5]

Here is Medicare's definition of a "treating physician" :

Medicare statute defines treating physician as one "...who furnishes a consultation or treats the beneficiary for a specific medical problem and who uses the [diagnostic x-ray tests, diagnostic laboratory tests and other diagnostic tests] results in the management of the beneficiary's specific medical problem." In a scenario where the beneficiary visits their primary care provider (PCP) who then refers the beneficiary to a sleep specialist for a polysomnogram and subsequent treatment with PAP and follow-up, both the PCP and the sleep specialist would be considered a "treating physician" within the context of Medicare regulations. Both physicians are engaged in diagnosing and treating the beneficiary for sleep disordered breathing. This scenario is quite common in medical practice where the primary medical care for the patient is rendered by the PCP and subspecialty physician consultation is engaged for specific diagnostic and/or therapeutic treatment outside the scope of the PCP's area of medical expertise.

[vwolford]

Medicare has stated to us that the MD that orders the O2 Sat / ABG must be the one to sign the CMN. In hospital discharge, the hospitalist is the one who "orders" the O2 Sat and therefore is the one to sign the CMN, then we were told that a follow-up appt with the PCP would require a "revised" CMN to be in your Med. Records.

[Sleeping410]

When you say "Medicare" told us, specifically who are you referring to? A customer service rep at the medicare contractor, an OIG auditor at your facility?

[cparks]

Does it matter? You get a different answer every time you call Medicare no matter who you talk to. I am being a bit facetious but you know what I mean.

[Sleeping410]

I understand your problems, but I stick by the answer posted, that in an audit situation (especially with the required face to face documentation about the ongoing results of the use of equipment) you should have a signed cmn and progress notes all from your patients treating physician. That may be the primary care or it may be a pulmonologist or someone else, it just has to be the person responsible for the treatment of the patients diagnosis that requires the oxygen.