Certificate of medical necessity
Encyclopedia
Generally, a Certificate of Medical Necessity is a piece of paper required by Centers for Medicare and Medicaid Services
to substantiate the medical necessity
of an item of durable medical equipment
furnished to a Medicare
beneficiary. It is essentially like a detailed prescription.
A CMN generally contains 6 places where a date can be entered:
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
to substantiate the medical necessity
Medical necessity
Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Other countries may have medical doctrines or legal rules covering broadly similar grounds...
of an item of durable medical equipment
Durable medical equipment
Durable medical equipment is a term of art used to describe any medical equipment used in the home to aid in a better quality of living. It is a benefit included in most insurances. In some cases certain Medicare benefits, that is, whether Medicare may pay for the item...
furnished to a Medicare
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
beneficiary. It is essentially like a detailed prescription.
A CMN generally contains 6 places where a date can be entered:
- The "initial date" of the CMN
- The "revised date" of the CMN
- The "recertification" date (usually for oxygen)
- The date the beneficiary signed it
- The date the supplier signed it and
- The date the physician signed it..
External links
- Physician's News Digest article on Certificates of Medical Necessity
- Statutory definition of a CMN at the SSA website
- Medicare manual that provides exhaustive information about the practical use of CMNs, particularly section 5.3. This is the official source of information for contractors administering the Medicare system about the use of CMNs.