| NHIC, Corp.DME MAC A ListServe | For Immediate Release |
| August 28, 2009 Oxygen & Supplies CERT Physician Letter Dear Physician:The Comprehensive Error Rate (CERT), Contractor under contract with the Centers for Medicare & Medicaid Services (CMS), performs medical review for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) provided to Medicare beneficiaries to determine paid claims error rates for Medicare contractors and providers. It is your responsibility as the ordering physician to determine and document the medical need for all healthcare services.The CERT Contractor may request that the supplier obtain this information from you in order to verify that Medicare coverage criteria have been met. The supplier must submit the documentation to CERT within 75 days from the date of the first initial request letter.For Oxygen and Oxygen Equipment to be covered by Medicare, the patient's medical record must contain sufficient information about the patient's medical condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or replacement (if applicable). As the treating physician, you are responsible for the following:A complete order that includes the liter flowReviewing, signing, and dating the Certificates of Medical Necessity (CMN) in a timely mannerDocumenting an in-person evaluation within 30 days prior to the date of initial CMNDocumenting an in-person re-evaluation within 90 days prior to the date of any recertificationOngoing documentation of the medical management of the patient's oxygen use in the patient's recordDMEPOS suppliers are your partners in caring for your patient. They will not receive payment from Medicare for the items that are ordered if you do not provide information from your medical records when it is requested. Furthermore, not providing this information may result in your patients having to pay for the item themselves. Finally, your cooperation is a legal requirement as outlined in the Social Security Act, the law governing Medicare: In accordance with 42U.S.C. 1320C-5 (a) (3) and 1833 of the Social Security Act, as a Medicare provider, you must provide documentation and medical records to the CERT contractor upon request to support claims for Medicare services. It is your responsibility to obtain additional supporting documentation from a third party (hospital, nursing home, etc.), as necessary. Providing medical records of Medicare patients to the Comprehensive Error Rate Testing (CERT) contractor is within the scope of compliance with the Health Insurance Portability and Accountability Act (HIPAA).You may not charge the supplier or the beneficiary to provide this information to the supplier.Help your DMEPOS supplier continue to provide good service to your patients by promptly providing the information from your medical records that is requested.DO NOT send medical records directly to the DME MAC. Provide them to the equipment supplier who originated this request.Thank you. |
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