Title:Durable Medical Equipment Medicare Administrative Contractor Certificate of Medical Necessity and Supporting Documentation Requirements;Use:The certificates of medical necessity (CMNs) collect information required to help determine the medical necessity of certain items. CMS requires CMNs where there may be a vulnerability to the Medicare program. Each initial claim for these items must have an associated CMN for the beneficiary. Suppliers (those who bill for the items) complete the administrative information (e.g., patient's name and address, items ordered, etc.) on each CMN. The 1994 Amendments to the Social Security Act require that the supplier also provide a narrative description of the items ordered and all related accessories, their charge for each of these items, and the Medicare fee schedule allowance (where applicable). The supplier then sends the CMN to the treating physician or other clinicians (e.g., physician assistant, LPN, etc.) who completes questions pertaining to the beneficiary's medical condition and signs the CMN. The physician or other clinician returns the CMN to the supplier who has the option to maintain a copy and then submits the CMN (paper or electronic) to CMS, along with a claim for reimbursement. This clearance request is for CMNs with the form numbers, CMS 846-849, 10125 and 10126.Form Numbers:CMS-846, 847, 848, 849, 10125, 10126 (OCN: 0938-0679);Frequency:Occasionally;Affected Public:Individuals or Households;Number of Respondents:462,000;Total Annual Responses:462,000;Total Annual Hours:92,400. (For policy questions regarding this collection contact Doris Jackson at 410-786-4459. For all other issues call 410-786-1326.)
To obtain copies of the supporting statement and any related forms for the proposed paperwork collections referenced above, access CMS' Web Site address athttp://www.cms.hhs.gov/PaperworkReductionActof1995, or Email your request, including your address, phone number, OMB number, and CMS document identifier, toPaperwork@cms.hhs.gov,or call the Reports Clearance Office on (410) 786-1326.
In commenting on the proposed information collections please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be submitted in one of the following ways byNovember 23, 2012:
1.Electronically.You may submit your comments electronically tohttp://www.regulations.gov.Follow the instructions for "Comment or Submission" or "More Search Options" to find the information collection document(s) accepting comments.
2.By regular mail.You may mail written comments to the following address:CMS, Office of Strategic Operations and Regulatory Affairs,Division of Regulations Development,Attention: Document Identifier/OMB Control Number ____ ,Room C4-26-05,7500 Security Boulevard,Baltimore, Maryland 21244-1850.