Electronic Submission of Medical Documentation (esMD)

On September 15, 2011, in Documents, by AQ-IQ LLC

Each year, the Medicare Fee-For-Service (FFS) Program makes billions of dollars in estimated improper payments. CMS employs several types of Review Contractors to measure, prevent, identify, and correct these improper payments. For more information about Medicare improper payments, go to www.paymentaccuracy.gov

Review Contractors find the improper payments by selecting a small sample of claims, requesting medical documentation from the provider who submitted the claims and manually reviewing the claims against the medical documentation to verify the providers’ compliance with Medicare’s rules.

Currently, Review Contractors request medical documentation by sending a paper letter to the provider. These providers usually have only 2 options for submitting the requested records:

1. mail paper or
2. send a fax

CMS intends to give providers a new mechanism for submitting medical documentation. CMS calls this new mechanism the Electronic Submission of Medical Documentation (esMD) pilot.

During Phase 1 of esMD, Providers will still receive medical documentation requests via paper mail but will have the option to electronically send medical documentation to the requesting Review Contractor. Phase 1 of esMD went live on September 15, 2011.

During Phase 2 of esMD, Providers will receive electronic documentation requests when their claims are selected for review. CMS plans to go live with esMD Phase 2 in October 2012.

For a graphical depiction of esMD click here

 

Comments are closed.