Electronic Submission of Medical Documentation (esMD)Transactions
On September 15, 2011, the Centers for Medicare & Medicaid Services (CMS) implemented the Electronic Submission of Medical Documentation (esMD) system which enables providers tosend medical documentation to review contractors electronically. The system is Exchange compatible, based on standards developed by the Office of the National Coordinator (ONC) for Health Information Technology.
Medicare providers and review contractors believe that using the esMD system results in cost savings and increased efficiencies. The esMD system may help improve the payment turnaround time and reduce the administrative burden associated with medical documentation requests and responses. Insufficient documentation errors generally account for a large proportion of improper payments. Some Fee-for-Service (FFS) medical review errors result from providers failing to submit the necessary documentation to support the claims. The use of the esMD system may help reduce improper payments.
CMS uses several types of review contractors to measure, prevent, identify and correct improper payments or find potential fraud. These review contractors request medical documentation from the providers who submitted the claims, and review the claims against the medical documentation to verify the providers? compliance with Medicare rules. To comply with the Review Contractor?s requests for documentation, hospitals, physicians and other medical providers send medical documentation via mail, fax or esMD to the review contractor. Using the esMD system is not mandatory for providers. Review Contractors are prohibited from targeting providers for medical review as a result of their esMD usage. 1 Additionally, esMD system transactions are safe and secure since the esMD system uses ONC?s Exchange gateway standards.
The Electronic Submission of Medical Documentation (esMD) system allows review contractors to electronically receive responses to Additional Documentation Request (ADR) letters sent by providers and Health Information Handlers (HIHs) during the claims review process. As the Centers for Medicare & Medicaid Services (CMS) enhances esMD functionality, review contractors may elect to participate in specific services offered on the expanded esMD menu. The following tables display which review contractors participate in the various types of additional esMD transaction services. Currently, the esMD system delivers the following types of electronic medical documentation in either Portable Document Format (PDF) or Extensible Markup Language (XML) format.
- Prior Authorization (PA) requests and review results for Power Mobility Devices (PMD)
- Prior Authorization requests for Repetitive Scheduled Non-Emergent Ambulance Transport
- First level appeal requests
- Recovery Auditor discussion requests
- Advanced Determination of Medical Coverage (ADMC) requests
Which Review Contractors offer Electronic Submission of Medical Documentation (esMD) services?
- Recovery Auditors
- Part A/B Medicare Administrative Contractors (A/B MAC)
- Durable Medical Equipment Medicare Administrative Contractors (DME MAC)
- Zone Program Integrity Contractor (ZPIC)
- Other Contractors