Article Detail - JF Part A

As part of its ongoing efforts to increase access to care and to reduce unnecessary administrative burden for stakeholders, CMS will be discontinuing the use of certificates of medical necessity (CMNs) and durable medical equipment (DME) information forms (DIFs) for claims with dates of service on or after January 1, 2023. CMS suppliers must continue to submit CMN and DIF information for claims with dates of service before January 1, 2023, if it’s required.

This change in process aligns with the Biden-Harris Administration’s priority of improving access to quality, affordable care, and coverage by enabling quicker access to needed medical supplies for people with Medicare. It also enables frontline clinicians to focus on providing direct care and streamlines the coverage process for suppliers.

Originally, CMS required the CMNs and DIFs to help document medical necessity and other coverage criteria for selected DME. Through stakeholder outreach, CMS received feedback that CMNs and DIFs are burdensome and duplicative of information already available on the claim or in the medical record. Additionally, CMS heard that submission of these forms is often particularly difficult for small or rural providers without administrative staff and technical support. In response to this feedback, CMS evaluated options for easing this process and determined it could end the use of these forms.

For more information, see MLN Matters Article SE22002 (PDF).

Source: CMS MLN Connects dated August 18, 2022