Get Certificate Of Medical Necessity - Cms

This guide provides clear, step-by-step instructions for filling out the CERTIFICATE OF MEDICAL NECESSITY - Cms online. Understanding this form is essential for ensuring that necessary medical equipment is properly authorized for patients.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to access the CERTIFICATE OF MEDICAL NECESSITY - Cms and open it in your editing application.
2. In Section A, indicate the certification type and date by filling in the initial or revised date as appropriate and provide the patient’s name, address, telephone number, and health insurance claim number (HICN). Include the supplier’s name, address, telephone number, and National Supplier Clearinghouse (NSC) number.
3. Specify the place of service where the equipment will be utilized, and if applicable, provide the name and address of the facility. Fill in the patient's date of birth, height, weight, and sex in this section.
4. Enter the physician's name, address, Unique Physician Identification Number (UPIN), and their contact telephone number.
5. In Section B, avoid completing this section if you are the supplier. Provide the estimated length of need in months and enter the appropriate diagnosis codes (ICD-9) in the designated spaces. Answer questions 1 and 3-7 accurately by circling Y for yes, N for no, or D for does not apply.
6. If another individual answers the questions in Section B, they must print their name, title, and employer’s name in the provided space.
7. In Section C, the supplier needs to provide a narrative description of equipment, its costs, and Medicare’s fee schedule allowance. Include all ordered items, accessories, and options.
8. In Section D, the physician must review the information in Sections A, B, and C, sign, and date the form. Ensure that the physician's signature is not a stamp.
9. Once all sections are completed, save the changes, download the document, print it, or share it as needed.

Start filling out the CERTIFICATE OF MEDICAL NECESSITY - Cms online today to ensure timely and appropriate medical equipment for your patients.