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Discontinuing Use of Certificates of Medical Necessity & Durable Medical Equipment Information Forms

Thursday, August 18, 2022


Claims, Pricers, & Codes


MLN Matters® Articles



CMS Discontinuing the Use of Certificates of Medical Necessity and Durable Medical Equipment Information Forms to Increase Efficiency and Reduce Burden for Clinicians, DME Suppliers, and Beneficiaries

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).


Quality Payment Program: Comment on Proposed Changes by September 6

CMS recently issued proposed policies for the Quality Payment Program (QPP) 2023 performance year. Submit comments on these changes in the Calendar Year 2023 Physician Fee Schedule proposed rule by September 6.

More Information:

  • Press release
  • Proposed Rule Resources (zip file): Get the overview fact sheet, policy comparison tables, Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) proposals, and MVPs tables


Skilled Nursing Facilities: Participate in Interoperability Survey

IQVIA is conducting a survey for the HHS Office of the National Coordinator for Health Information Technology to assess skilled nursing facility (SNF) capabilities related to interoperability, electronically exchanging information across organizations and systems. This may improve care transitions between acute-care and post-acute care facilities.

Why participate?

  • Your responses will help develop future federal policies
  • It’s an easy 10-minute phone call
  • Only 1 person from your facility needs to speak to an IQVIA team member
  • You don’t need electronic health records (EHRs) to participate

Answer questions about how your SNF:

  • Uses (or doesn’t use) EHRs
  • Exchanges clinical information electronically with hospices and other organizations

Choose how to participate:

  • Call 917-542-5651 between 9 am – 5 pm ET (Monday – Friday)
  • Register, and IQVIA will call at a time that’s convenient for you; you’ll see 917-542-5651 on caller ID


Home Health: Revised Guide to Help Desks

If you’re a home health provider, find out how to get answers to your questions with the revised 1-page Guide to Home Health Help Desks (PDF).


Claims, Pricers, & Codes

Claim Status Category and Claim Status Codes Update

Learn about claims status category and code updates effective October 1, 2022:

See the instruction to your Medicare Administrative Contractor (PDF).



Home Health OASIS-E Virtual Workshops — September 13 & 14

Tuesday, September 13 & Wednesday, September 14 from 1–5 pm ET

Participate in a 2-part training for the Home Health (HH) Quality Reporting Program (QRP):

Part 1: Watch training videos to learn about changes effective January 1, 2023:

  • Outcome and Assessment Information Set Version E (OASIS-E)
  • Standardized patient assessment data elements for consistent reporting and evaluation across post-acute care (PAC) settings

Part 2: Register for live, virtual workshops that provide practice coding scenarios on the items covered in the training videos.

More Information:

  • Resources (ZIP): Get an acronym list, action plan worksheet, resource guide, case study documents, and PDF versions of the training webinars
  • PAC Training Mailbox: Ask questions about accessing resources or provide training feedback
  • HH QRP Help Desk: Ask content questions


MLN Matters® Articles

International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) — January 2023 Update

Learn about ICD-10 conversions and other coding updates (PDF).


International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) — January 2023 Update – 2 of 2

Learn about ICD-10 conversions and other coding updates (PDF).


Quarterly Update for Clinical Laboratory Fee Schedule (CLFS) and Laboratory Services Subject to Reasonable Charge Payment

Learn about changes effective October 1, 2022 (PDF):

  • Delayed reporting period for clinical diagnostic laboratory tests
  • Updates to advanced diagnostic laboratory tests
  • New HCPCS codes


Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, and Hospice Pricer for FY 2023

Learn about changes effective October 1, 2022 (PDF).


Remittance Advice Remark Code (RARC), Claims Adjustment Reason Code (CARC), Medicare Remit Easy Print (MREP) and PC Print Update — Revised

CMS changed a date in the code update schedule (PDF) to August 1 (previously July 1).

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