News

Does ADMC accept templates?

Date Published: April 04 2014

The Centers for Medicare & Medicaid Services (CMS) has published in various regulations, pronouncements and other directives, the exact information they are looking to have addressed when a face-to-face encounter occurs.

CMS has also published information in the Program Integrity Manual (see below for exact language) regarding templates. While DMEevalumate.com is not really a template per se, a template is the closest category that our program falls into that CMS recognizes, so we have chosen to define and differentiate ourselves within that category. CMS tells physicians and DME suppliers what is required, but doesn't tell them how, or what is the best method to obtain the documentation (no guarantees). Simply put, there are no methods, processes, programs, forms or templates that CMS endorses, however they do not prohibit the use of templates and (as noted below) encourage physicians to select one that enables them to enter detailed notes.

The exact language regarding templates from the Program Integrity Manual, Section 3.3.2.1.1: 

“CMS does not prohibit the use of templates to facilitate record-keeping. CMS also does not endorse or approve any particular templates. A physician/LCMP may choose any template to assist in documenting medical information.

Some templates provide limited options and/or space for the collection of information such as by using "check boxes," predefined answers, limited space to enter information, etc. CMS discourages the use of such templates. Claim review experience shows that that limited space templates often fail to capture sufficient detailed clinical information to demonstrate that all coverage and coding requirements are met.

Physician/LCMPs should be aware that templates designed to gather selected information focused primarily for reimbursement purposes are often insufficient to demonstrate that all coverage and coding requirements are met. This is often because these documents generally do not provide sufficient information to adequately show that the medical necessity criteria for the item/service are met.

If a physician/LCMP chooses to use a template during the patient visit, CMS encourages them to select one that allows for a full and complete collection of information to demonstrate that the applicable coverage and coding criteria are met.

Certificates of Medical Necessity (CMN), DME Information Forms (DIF), supplier prepared statements and physician attestations by themselves do NOT provide sufficient documentation of medical necessity, even if signed by the signed by the ordering physician. See PIM §5.7 for additional information on documentation.”

DMEevalumate.com's online algorithmic program for face-to-face evaluations has infinite character fields to enable the practitioner to enter detailed notes, often referred to as a narrative. The program walks the practitioner through Medicare coverage criteria to ensure questions regarding medical necessity are addressed. If the practitioner determines that a patient does meet medical necessity (as identified by the CMS guidelines and questions addressing them) they move on to the next question. If a patient does not meet medical necessity for a specific piece of equipment, alternative equipment questions are asked. At the end of the face-to-face evaluation, DMEevalumate.com produces the appropriate and compliant face-to-face documentation (face-to-face notes and detailed written orders) as a PDF that can be saved and uploaded to any electronic medical record.

For more information go to DMEevalumate.com resource page at www.dmeevalumate.com/CMS

Back to news