CERTIFICATE OF MEDICAL NECESSITY QUESTIONS
| NOTE: Questions in this section should be answered accurately to reflect the true condition of the patient. Your answers to specific questions are used by Medicare to establish whether specific items are reimbursable. NOTE: This CMN is only used for Air Fluidized Beds. It is no longer required for Alternating Pressure Pads or Mattresses.
Question 12: This question is no longer applicable for equipment requiring this CMN.
Question 13: The caregiver must be supervising the use of the device to qualify for Medicare reimbursement.
Question 14: Patients who have coexisting pulmonary disease DO NOT qualify for Medicare reimbursement.
Question 15: A conservative treatment program must first have been tried without success to qualify for Medicare reimbursement.
Question 16: A comprehensive assessment must be performed after failure of conservative treatment to qualify for Medicare reimbursement.
Question 19: Open, moist dressings used for the treatment of the patient protected with an impervious covering qualify for Medicare reimbursement.
Question 20: A trained full-time caregiver who assists the patient and manages all aspects involved with the use of the bed must be present to qualify for Medicare reimbursement.
Question 21: Patients who have a stage 3 or stage 4 pressure sore qualify for Medicare reimbursement.
Question 22: Leave blank for the initial CMN. For recertification, the physician may need to supply additional documentation which describes any changes in the treatment regimen which have been made or are planned to qualify for Medicare reimbursement.
NOTE: Written order prior to delivery (WOPD) is required. The CMN for Air Fluidized Beds may be used as the WOPD as long as it is signed and dated by physician prior to delivery.
Information courtesy of Health-E-Quip
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