The initial concept of electronic certificates of medical necessity (e-CMNs) was born only a few years ago thanks to a handful of forward-thinking pioneers in the medical industry. Ushered in by advances in Web-based technologies, cheaper computer hardware, fast Internet and network connections, and secure digital signatures, e-CMNs promised to dramatically reduce documentation turnaround time between providers and physicians.

But it was not until the Centers for Medicare and Medicaid Services approved the use of e-CMN technology 2 years ago that the idea began to be fully developed.

Because pending documentation can result in a bottleneck to cash flow in an industry where managing cash flow is essential, one might have predicted that e-CMN technology would be rapidly embraced by providers. But even though mature e-CMN products are now available, their use is still not yet widespread.

Why is this and what will it take for the use of this technology to become commonplace among providers and physicians?

Expanding e-CMN Awareness
When Dealer/Provider looked at the state of the e-CMN initiative last year, there were only a few vendors developing the technology, and the American Association for Homecare (AAHomecare) had formed a working group to discuss ways to standardize the technology in order to make it more attractive for physicians and providers to adopt. No tremendous changes have come about in the past year when it comes to the number of vendors involved in developing e-CMN products, yet a good deal of progress has been made by those who have sought to advance the case for e-CMNs.

In the intervening year, the technology has been refined, an e-CMN feature has been integrated with a few of the larger HME software systems on the market, and some HME system software vendors have even begun to talk of developing their own e-CMN products. There is no doubt that everyone involved in developing and promoting the technology remains bullish on the possibilities.

While acknowledging that change typically comes slowly to the health care billing industry, one of the industry’s largest e-CMN providers reports that it currently has more than 1,000 physicians signed up in 35 states at 450 locations representing 15 HME companies. That is a substantial increase from even a year ago.

In addition, the industry has become more comfortable with the idea that e-CMNs can be treated as original documents, and articles by industry experts and the endorsement of the technology by groups like VGM have accelerated the awareness of and interest in e-CMNs.

From a user perspective, e-CMN programs are easy to operate. Currently, there are two varieties of e-CMN products to choose from—a Web-based interface and a “thin client,” which requires both the provider and the physician to install a small program on their computers. The provider side of both of these program types allows the HME company employee to enter only the information on the CMN that may be legally completed by the HME dealer—a feature that should give HME company owners one less thing to worry about when it comes to ensuring that their company remains compliant with Medicare regulations. Plus, as an added bonus, programs that are integrated with HME billing software pull the required information from the HME software database, thus reducing redundant data entry.

All the systems currently available also allow the creation of cover letters, and maintain an archive of both completed and pending CMNs. In addition, reporting tools allow employees who are responsible for medical documentation to track the current status of the documents they have prepared and requested. With program developers planning or recently introducing new e-CMN features such as electronic detailed written order capabilities, there is at least a potential that one day all forms of medical necessity documentation will be transmitted electronically.

Getting Physicians on Board
The question that still looms is what it will take to get there. Most everyone agrees that it is physician adoption of the technology that is the key to making electronic exchange a routine method of securing medical documentation. So how do we get physicians on board?

Studies have shown that the majority of physicians do use computers and the Internet on a routine basis, so they are not adverse to the technology. However, in order for physicians to sign on to emerging technologies, like e-CMNs, they will have to see a real savings in either time or money. Since the cost of using the software is borne by the HME provider, it is money saved by increases in the efficiency of documentation completion that should be attractive to physicians.

The benefits of electronic document exchange should not be hard to prove to physicians. The software provided to physician’s offices is just as intuitive as that used by HME companies. Most e-CMN products notify subscribing physicians or their designated office staffs via email that there are CMNs waiting in a database for electronic completion. A link in the email takes them to the database where the e-CMNs reside. After logging into the secure server, physicians use a point and click interface to complete sections B and D of the CMNs, then attach their own digital signatures to the e-CMNs. If physicians’ office staff members complete the CMNs instead, they go into a queue for the physicians to review and digitally sign later.

Once an e-CMN has been completed and digitally signed, the HME provider is notified via email that it is ready to be retrieved. The provider can save the e-CMN to a local server and also print it. An archive of completed e-CMNs remains on the e-CMN vendor’s server, protected by high levels of security and daily backups.

Vendors May Help
E-CMN vendors can assist acceptance of the technology through their own sales forces and by working closely with industry associations and key physician groups to get the word out about the benefits of e-CMNs.

Another smaller hurdle to overcome before there is a widespread acceptance of e-CMNs is standardization of the technology. Physicians may not embrace electronic documentation if they are faced with the prospect of maintaining multiple log-ins, passwords, and digital signatures for each e-CMN product. However, with only a few e-CMN products on the market at this time, it seems like a problem that lies in the future as competition grows and is not an issue hindering physician adoption of e-CMNs now.

Naturally, the future of the technology is a concern for organizations like AAHomecare, which has developed a working group to explore the e-CMN initiative. Joel Mills, chairman of the board of directors for AAHomecare, says that the organization is continuing to work on an industry-wide solution for e-CMNs and other electronic documentation.

“We are working on finding the best solution that meets the needs of all providers in the industry, as well as one that is compliant with all industry rules and regulations,” he says.

AAHomecare did not make any new announcements about e-CMNs at Medtrade, but Mills did indicate that the industry could expect some announcement from AAHomecare on the issue in the near future.

Technology is here to stay, and hopefully that means e-CMNs are as well. As the technology becomes standardized, and its availability becomes more widely known among providers and physicians, an increasing amount of medical documentation will be exchanged electronically. Ultimately though, it seems likely that it will be up to providers and e-CMN vendors to get physicians on board before the technology will really take hold.

Roberta Domos, RRT, is owner and president of Domos HME Consulting Group, a consulting firm in Redmond, Wash. For more information, contact her at (425) 882-2035, or visit her Web site at www.hmeconsulting.com.