Does the new policy change any information requirements concerning MAE?
No, the same types of information will be required. Suppliers are reminded that, in the event of a review by Medical Review or Benefit Integrity, they may be asked to provide medical records beyond the CMN that corroborate the medical need for the item provided. The medical records should describe the patient’s condition with enough details that it will allow us to apply the principles of the NCD and make an individual determination. Just repeating the phrases in the NCD will NOT be sufficient – i.e., if we just get a note from the physician that says “Mrs. X has obesity, osteoarthritis, and COPD and is at heightened risk of morbidity and can’t perform her MRADLs in a reasonable time frame”, that is not enough. We encourage suppliers to work with their referral sources to ensure the adequacy of the medical record. Back to Top.
