Empi works with medical professionals to ensure full compliance with Medicare/Medicaid so that patients may receive full benefit from the product(s) when medically necessary. Empi provides a guide for the proper completion of the Certificate of Medical Necessity (CMN), which is required by Medicare to substantiate medical necessity for our TENS device. Empi will file the claim on behalf of the patient to Medicare/Medicaid. You may contact a Medicare/Medicaid Specialist at (800)328-2536.
Requirements of the Prescribing Physician
The prescription should be transcribed on the physician's personalized pad. In addition to forwarding the written order to Empi, it is recommended that you maintain a copy of the document in your patient's file. The written order must contain the following:
• Patient's Name
• Description of the Item (TENS, NMES, PFS, etc.)
• Physician's Original Signature (no signature or date stamps)
• Date the Physician Signed the Prescription
• Diagnosis information
Additional documentation (i.e. Letter of Medical Necessity (LOMN) or CMN) may be required by the payor to substantiate medical necessity if not provided. Empi will contact the physician directly to obtain all necessary information.
Requirements of the Medical Professional
A copy of the patient's medical record(s) and/or progress notes should be available upon request. As a supplier, Empi may be required to submit such documentation at the request of the payor. Please retain a copy of the prescription in the patient's file.
Some payors may require that an Advance Beneficiary Notice (ABN) be signed by the patient prior to the dispense of product or the provision of a service. Providers are required to inform beneficiaries whenever it is likely that a payor may deny benefits. With an ABN, "you" may be able to protect "yourself" in the event of non-coverage. Medicare information regarding the ABN is available from the following link: http://cms.hhs.gov/medlearn/refabn.asp
Medicare Coverage Policies
Medicare has national coverage policies and local coverage policies which affect some procedures, supplies and DME. A national coverage policy means Medicare contractors must cover procedures, supplies or other DME if the conditions of the coverage policy are met. Most coverage policies are determined by local medical review policy (LMRPs). For LMRPs, the local Medicare carrier may determine coverage requirements. For DME, four regional specialized Medicare contractors, called Durable Medical Equipment Regional Carriers (DMERCs) process the claims for the entire country.
National Medicare Coverage Policies
Local Medical Review Policies
Medicare Coverage Issues Manual