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| Follow-up information to the Comprehensive Error Rate Testing (CERT) National Call on Sept 23, 2009. Question: What manual publication states that a Certificate of Medical Necessity (CMN) needs to have physician clinical documentation to validate the medical necessity of the CMN? Answer: According to the Centers for Medicare & Medicaid Services (CMS) Program Integrity Manual 100-8 Chapter 5, Section 5.7: "However, neither a physician's order nor a CMN nor a DIF nor a supplier prepared statement nor a physician attestation by itself provides sufficient documentation of medical necessity, even though it is signed by the treating physician or supplier. There must be information in the patient's medical record that supports the medical necessity for the item and substantiates the answers on the CMN..." |
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