insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be creBefore we begin our installment on G records for medical billing of claims using NSF 3.01 specifications, it may be a good idea to give a brief overview of what G records are for and why they are so special.

Because there are so many things that can possibly be done when it comes to the field of medicine, it is virtually impossible to be able to account for all of them in what we call standard specifications. The standard specifications are your AA0, BA0, CA0, DA0, F records and some other records that are soon to follow in this series. Aside from patient information, doctor or provider information, facility information and finally the actual item being billed, there is some information that needs to be transmitted only in certain cases.

The first thing we need to understand is why we have these special cases to begin with before we can even begin to describe what some of them are. The reason we have special cases really comes down to medical need or what they call medical necessity. Because some items can be so expensive, when there is a call for a certain item or procedure, the doctor has to present a clear medical necessity for that item or procedure. This is done by signing off on a CMN, or Certificate Of Medical Necessity. This needs to be sent to the payer to show that the item being ordered for the patient is needed. Now, this isn't done for a $2 test strip because the cost of processing these items would be greater than the cost of the item itself. No, this is done for items that are very expensive. This brings us to some examples.

A patient is injured in an auto accident. The patient is no longer able to walk, either permanently or at least temporarily and needs a wheelchair to get around in. Because of the expense of that wheelchair, assuming that it is covered by insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be crea

A0, BA0, CA0, DA0, F records and some other records that are soon to follow in this series. Aside from patient information, doctor or provider information, facility information and finally the actual item being billed, there is some information that needs to be transmitted only in certain cases.

The first thing we need to understand is why we have these special cases to begin with before we can even begin to describe what some of them are. The reason we have special cases really comes down to medical need or what they call medical necessity. Because some items can be so expensive, when there is a call for a certain item or procedure, the doctor has to present a clear medical necessity for that item or procedure. This is done by signing off on a CMN, or Certificate Of Medical Necessity. This needs to be sent to the payer to show that the item being ordered for the patient is needed. Now, this isn't done for a $2 test strip because the cost of processing these items would be greater than the cost of the item itself. No, this is done for items that are very expensive. This brings us to some examples.

A patient is injured in an auto accident. The patient is no longer able to walk, either permanently or at least temporarily and needs a wheelchair to get around in. Because of the expense of that wheelchair, assuming that it is covered by insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be cre

ason we have special cases really comes down to medical need or what they call medical necessity. Because some items can be so expensive, when there is a call for a certain item or procedure, the doctor has to present a clear medical necessity for that item or procedure. This is done by signing off on a CMN, or Certificate Of Medical Necessity. This needs to be sent to the payer to show that the item being ordered for the patient is needed. Now, this isn't done for a $2 test strip because the cost of processing these items would be greater than the cost of the item itself. No, this is done for items that are very expensive. This brings us to some examples.

A patient is injured in an auto accident. The patient is no longer able to walk, either permanently or at least temporarily and needs a wheelchair to get around in. Because of the expense of that wheelchair, assuming that it is covered by insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be cre

isn't done for a $2 test strip because the cost of processing these items would be greater than the cost of the item itself. No, this is done for items that are very expensive. This brings us to some examples.

A patient is injured in an auto accident. The patient is no longer able to walk, either permanently or at least temporarily and needs a wheelchair to get around in. Because of the expense of that wheelchair, assuming that it is covered by insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be cre

insurance, the insurance company, carrier, or payer, requires the doctor to sign off on this wheelchair that there is indeed a medical need for it. If it turns our through investigation that the patient didn't need the wheelchair, the doctor is liable. This certificate that he signs off on is called a CMN. There is an actual paper CMN that is sent to the payer, but because when electronically billing no paper is sent, an electronic record must be created to transmit these CMNs. There are all kinds of CMNs. Way too many to get into in this article. Because of this, a generic record type needed to be created for each type of CMN. This is where your G records come from and there are a number of them.

In the first installment of our CMN series, we're going to cover the GA0 record, which is a CMN that needs to be sent for a patient that was taken to the hospital by ambulance. Yes, it needs to be shown that the ambulance ride was medically necessary for the patient or the claim for the ambulance ride will not be paid. CMNs are big business. After reading the next few installments, you'll understand why.