Following the recent announcement by the Centers for Medicare & Medicaid Services (CMS), starting with claims with a date of service on and after 01/01/2023 will drop the need for certificates of medical necessity (CMNs) and DME information forms (DIFs).
So, what does this mean for DME suppliers? Suppliers can minimize losses and lower administrative costs associated with obtaining these antiquated documentation requirements. Without the need to get CMNs and DIFs, DME suppliers can increase cash flows, improve service delivery, and reduce the risk of chargebacks.
Eliminating requirements for these certificates and DME forms is a dream come true for durable medical equipment suppliers.
Suppliers will not have to chase around doctors to fill out forms or endure denials and audits because of missing information. However, before January 1, 2023, you still have to submit the CMNs and DIFs.
Benefits of the CMS Removal of CMNs and DIFs
1. Reduce Administrative Burden
CMS continues to roll out reforms to reduce the administrative burden affecting the DME/HME industry. By eliminating the need to fill medical necessity forms, you don’t have to worry about waiting for doctors to sign forms and ink their signatures. Usually, you need a signed order and an electronic CMN or DIF to submit with a claim and documentation follow-up will reduce drastically by implementing the new CMS directive.
Previously, audit reports could show missing documentation, something that may attract charge paybacks or even worse litigation. If CMNs and DIFs do not provide sufficient information about claims, it leads to automatic denial. Missing dates, signatures, or miscoded units create audit risks, which may lead to revenue loss. When the new CMS guidelines take effect, you’ll be able to submit your claims without enduring the tedious and expensive process of obtaining the required forms and certifications.
2. Fast and Efficient Billing
Heavy documentation remains the primary hurdle to seamless DME billing operations. With many documents to fill and verify, suppliers and clinicians can wrongly bill payers, leading to denials that prolong the revenue cycle. Removal of CMNs and DIFs is a major boost to the billing process as it implies a reduction of documents one has to verify before submitting a claim.
When you bill according to coverage determinations and CMS requirements, you’re likely to avoid denials and payment delays. Having eliminated the need for equipment necessity certifications, CMS has made it easier for you to bill claims faster and accurately. Remember until January 1, 2023, you still have to submit the correct certifications.
3. Minimize Audit Risks
Staying at the top of your game with DME compliance is important in speeding up payments and reducing audit risks. Post-payment auditing can occur months or years after submitting claims. Whenever physicians are unwilling or cannot produce the much-needed documentation on time, it can cause errors that cause auditing.
Sometimes, the documentation released by the physicians does not match the data in the submitted claims. As a DME/HME supplier, missing or incorrect information can expose your business to auditing risks.
4. Reduce Losses and Increase Profits
For HME/DME suppliers, streamlining billing results in increased profits and improved service delivery. However, improper DME billing causes a decrease in collections, audit risks, and a surge in denials. Through the elimination of the CMNs and DIFs, providers will now enjoy faster claim submission and resolution.
Since suppliers will have a few documents to chase and obtain from referrals, they can submit claims easily and receive payments quickly.
Billing durable medical equipment can be complicated and time-consuming. With the right dme billing software provider – NikoHealth – can streamline processes and integrate them into one simple and intuitive solution.