Q. In September 1999 the DMERC published an article, Timeliness of CMNs, which described the requirement that,
"... if greater than 3 months passes from the time a CMN is completed and signed by the physician and the item being ordered is delivered, a new CMN will have to be completed and signed for submission of a claim...".
The instructions for ADMC, published in June 2001, state,
" An affirmative ADMC is only valid for items delivered within 6 months following the date of the determination. If the wheelchair is not delivered within that time, the supplier has the option of either submitting a new ADMC request (prior to providing the item) or filing a claim (after providing the item).
These two requirements appear to contradict one another by allowing different intervals for the validity of a CMN. Can you resolve this apparent contradiction?
A. The September 1999 article describes the general requirements applicable to all items requiring a CMN, most of which do not make use of the ADMC process. The ADMC process allows for a longer interval and supercedes the timeframe set in the 1999 article only for those items for which a valid ADMC determination has been made.
Thus, if an affirmative ADMC was received for the item, and the item was delivered to the patient after 90 days, a new initial CMN is not needed because the ADMC allows for delivery within 6 months.
If the item did not go through the ADMC process and was delivered after 90 days, a new initial CMN is required to establish that the item is medically necessary.
ref CR 1187, 1773