October 4, 2011

CMS Goes Live with Electronic Solution for Submitting Medical Records

By

c-buckThe new Electronic Submission of Medical Documentation (esMD) pilot from the Centers for Medicare & Medicaid Services (CMS), which allows providers to submit medical record documentation electronically and voluntarily, has gone live in some RAC regions, according to Melanie Combs-Dyer, RN, the deputy director of the Provider Compliance Group in the CMS Office of Financial Management.

 

The launch marks the beginning of a two-phased program. Phase two, scheduled to begin in October 2012, will allow Review Contractors to send documentation requests to selected providers electronically.

 

Under esMD, providers will be able to reply to Review Contractors’ requests through secure electronic responses employing Nationwide Health Information Network (NHIN) standards.

 

Currently, Medicare Fee-For-Service Review Contractors request medical documentation from providers using letters sent by mail. Providers have two options for submitting the requested records: by mail or fax.

 

The Medicare Fee-For-Service (FFS) Program makes an estimated $36.3 billion in improper payments each year. CMS employs several types of Review Contractors to measure, prevent and identify such payments, and to help CMS correct them.

 

Review Contractors find the improper payments by selecting a sample of claims, requesting supporting medical documentation from the provider submitting the claims, and manually comparing the claims with the medical documentation to verify the provider’s compliance with Medicare rules.

 

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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