Common Scenario Chart Requirement for Type of CMN/DIF/Order and Additional Information When Billing Claims

Suppliers frequently ask questions about what type of CMN/DIF/Order or information should be submitted for a given situation, Break in Billing or Break in Need or Service being the most common situations. The Common Scenario Chart provides guidance on those situations and what type of narrative may be required when billing.

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Scenario Type of CMN/DIF
when applicable
Comments
Break in Need or Service (BIN)
More than 60 days with change in medical condition
Initial CMN for initial claim Add narrative on claim line "BIN"
Break in Billing (BIB)
More than 60 days with no change in medical condition Less than 60 days with or without change in medical condition
None Add narrative on claim line "BIB" with explanation of break in billing, i.e., beneficiary entered a hospital, Skilled Nursing Facility (SNF)
Change in supplier (no break in need or service) Revised CMN in supplier's files In an acquisition, the original may be used if it is available. Add narrative to claim line "previous supplier XXXXXXXXX" (Name of previous supplier)
Initial CMN did not qualify, patient retested and now qualifies Initial The initial date should be the date of the qualifying test
Group II oxygen patient not retested within 61–90th day Recertification The recertification date should be the date of the clinician visit.
Group I oxygen patient with a length of need less than or equal to 12 months (but not lifetime) and not retested 30 days prior to revision Revised The revised date should be the date of the clinician visit.
Group I oxygen patient with lifetime length of need, not seen and evaluated by the physician within 90 days prior to the 12-month recertification but subsequently seen Recertification The recertification date should be the date of the clinician visit.
Portable oxygen was added after stationary Revised  
Stationary oxygen was added after portable Revised  
Change in oxygen modality None If the clinician is requesting this change, a new order is required.
Changed billing assignment (non-assigned to assigned) None  
Change in doctor Revised in supplier's files  
Change in oxygen liter flow Revised if change in payment category, e.g., from 4 LPM to 5 LPM. None if payment category does not change  
Change from Medicare secondary payor to Medicare FFS primary payor None All requirements must be met originally for Medicare as secondary payor
Change from non-Medicare insurance to Medicare FFS Initial The initial date should be the date of Medicare eligibility if the patient has a Medicare qualifying test within 30 days before their eligibility. If they do not get the qualifying test until after they become Medicare eligible, then the initial date should be the date of the qualifying test.

 

Last Updated Thu, 03 Jun 2021 12:50:21 +0000