Electronic Submission of Medical Docs Trial Goes Live

Article posted March 13, 2012 on HealthLeadersMedia.com

A year ago this month, CMS announced its esMD tool, which is an option for providers to electronically send medical documentation that is requested of them by recovery auditors and other government entities contractors.

Phase 1 of esMD kicked off on September 15, 2011. During this period, providers will still receive medical documentation requests via paper mail, but will have the option to electronically send their documentation to the requesting review contractor.

Region D recovery auditor HealthDataInsights plans to participate in the program starting this month, and Region C recovery auditor Connolly next month.

Benefits of  the esMD gateway
Ask any provider currently involved in its facility’s recovery audit program—or any government auditing contractor, for that matter—and they won’t hesitate to illustrate some of the correspondence issues that they are experiencing with the respective reviewing contractor. With the implementation of esMD, providers may find a decreasing administrative burden and improved submission tracking when it comes to record requests, suggests Amanda Berglund, MS, MBA, COO, Pace Healthcare Consulting, LLC.

“Right now, providers are still saving medical records to CD ROMs as PDF files and shipping these CD ROMs to contractors. Even though you’ve have a tracking number and somebody’s signed for it, the recovery auditor or the MAC may say they didn’t get it. The facility may need to recreate and reship the files to ensure acceptance within the set deadlines.”

“But with esMD, there’s an electronic trail and a report that indicates when the entity has received your medical records, whereas right now it’s very proactive; you have call UPS or FedEx, see who at the contractor signed for it, and check on claim status tool to see if it’s been received or not.”

The ultimate goal of the program is more than likely aimed toward converting the process to an all-online process, says Elizabeth Lamkin, MHA, and CEO of Pace Healthcare. In addition, the program is going to go a long way in protecting providers from a HIPAA standpoint.

“It will reduce paperwork and costs, but also, with everyone being mandated to go to an EHR system, this is the logical next step. Also, with the Office of Civil Rights all over HIPAA, this definitely makes sense from a security standpoint.”

In essence, sending electronic files via a secure connection directly to the recipient is not only a safer bet then paper mail, but clearly a better option overall.

Berglund says, “The ultimate point I’d make with esMD is that this is now available and providers should be using it, as it’s sure to be more effective, secure and expedient than sending your records out in the mail.”

As of September 2011, the following review contractors have been approved to participate in the esMD program:

Region A Medicare recovery audit  (DCS)

  • Region B Medicare recovery audit  (CGI)
  • Medicare administrative J1 (Palmetto GBA)
  • Medicare administrative J3 (Noridian)
  • Medicare administrative J4 (Trailblazer)
  • Medicare administrative J5 (WPS)
  • Medicare administrative J9 (First Coast)
  • Medicare administrative J11 (Palmetto)
  • Medicare administrative J12 (Highmark)
  • Medicare administrative J14 (NHIC)
  • Comprehensive error rate testing (CERT) contractor
  • Program error rate measurement (PERM) contractor
  • DME Medicarea JA (NHIC)
  • DME Medicare administrative JD (Noridian)
  • Medicare administrative J13 (NGS)
  • DME Medicare administrative JB (NGS)
  • Medicare administrative J10 (Cahaba)