June 21, 2012

CMS esMD Gateway Reports Success

By LTJG Joyce Davis

j-davisAs of June 15, 2012, the Centers for Medicare & Medicaid Services (CMS) has received 33,231 electronic additional documentation submissions via the Electronic Submission of Medical Documentation (esMD) Gateway.

That figure translates to 678 unique providers submitting responses since September 15, 2011. As of June 1, 2012, there are thirteen CMS certified esMD Health Information Handlers (HIHs). HIHs are organizations that handle medical documentation on behalf of providers.

At this time, only ten certified HIHs have sent live transactions via esMD. The CMS esMD Gateway and CMS certified HIH Gateways were constructed according to the Nationwide Health Information Network (NwHIN) standards to keep the medical information safe and secure as it travels along the internet to CMS.

Currently, electronic submissions sent to CMS via esMD are responses to Additional Documentation Request (ADR) letters sent by CMS review contractors to providers during the claims review process.

The inbound transactions accepted by the CMS esMD Gateway are scheduled to expand. Presently, the esMD Gateway only accepts responses to medical documentation requests. By the end of 2012, the CMS esMD Gateway will begin to accept unsolicited documentation (in PDF), Advance Determinations of Medicare Coverage (ADMC) requests, and Prior Authorization requests. Providers have asked if they could use esMD to submit appeal requests. We are talking with the CMS appeals staff to find out if, or when, this might be possible.

In future years, CMS hopes to expand the esMD system to allow providers to sign up to receive medical documentation requests and Prior Authorization Review results via esMD transactions as well. CMS's long-term goal is for review contractors to send all Review Results Letters and Demand Letters to providers via esMD.

About the Author

Joyce Davis, LTJG, is a Health Insurance Specialist in the Provider Compliance Group, Office of Financial Management, Centers for Medicare and Medicaid Services. Joyce graduated from the University of Management and Technology in Arlington, VA, where she obtained her Masters Degree in Information Technology.  Before joining CMS as a commissioned officer in the Public Health Service Corps, Joyce served in the United States Navy for 10 years. Joyce has been working at CMS a little over a year. In her current position, Joyce oversees the contractor QSSI, which developed CMS' CONNECT compatible gateway for the esMD initiative.

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