CMS went live on September 15, 2011 with Phase I of Electronic Submission of Medical Documentation(esMD). In Phase I providers will still receive medical documentation requests via paper mail, but have the option to electronically send medical documentation to the requesting Review Contractor. Phase II which is targeted to go live in October 2012 will allow providers to receive electronic documentation requests when their claims are selected for review.
Using the New System
First, determine if the Medicare Recovery Auditors and Medicare Administrative Contractors (MACs) from which they receive documentation request letters will accept esMD transactions.
Second, obtain access to an NHIN gateway. Providers can do this by building their own gateway that meets the requirements of the esMD Implementation Guide, or hiring a Health Information Handler(HIH) that offers esMD services. (See Resources below)
To date, the following Health Information Handlers(HIHs) have been certified by CMS to offer esMD gateway services to providers: HealthPort, IVANS, NaviNet, RISARC, MRO, and HealthIT Plus. Additional HIHs will become certified later this month.
The following Review Contractors have been approved to participate in the esMD program effective September 2011: DCS, CGI, Palmetto GBA, Noridian, Trailblazer, Wisconsin, First Coast, Highmark, CERT, PERM, NHIC, NAS and NGS. Additional Review Contractors will be added in January and April 2012.
About the Author
Melanie Combs-Dyer, RN, is Deputy Director, Provider Compliance Group, Office of Financial Management, Centers for Medicare & Medicaid Services. Melanie graduated from the University of Maryland School of Nursing and obtained her Masters Degree in Health Administration from Towson University. Before joining CMS, Melanie worked as a registered nurse and as a medical record reviewer for the Maryland Peer Review Organization and for the Maryland Health Department.
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