CMS announces electronic data submission tool for providers

HCPRO Website, February 16, 2011

As it currently stands, providers respond to documentation requests from review contractors such as recovery audit contractors (RACs) and Medicare administrative contractors (MACs) via mail or fax. As evidenced in the past, providers have had a number of problems with this form of coordination. Announced this week, however, is a new option that allows certain providers to make electronic data submissions.

CMS is referring to the new option as "esMD," (electronic submission of medical documentation.) Phase one of esMD will begin in April 2011. During this phase. according to CMS, review contractors will continue to send medical documentation requests via paper mail and providers will have the option to electronically send medical documentation to the contractor that request it.

Phase two, which CMS is hoping to implement in 2012,will see review contractors electronically sending documentation requests to providers when their claims are selected for review. As of now, the following review contractors are planning to participate in the esMD pilot beginning in April 2011:

  • The RACs for regions A, B and D
  • The MACs for jurisdictions 1, 3, 4, 5, 9, 10, 12, 13 and 14
  • The comprehensive error rate testing (CERT) contractor
  • The program error rate measurement (PERM) contractor

In addition, CMS anticipates the following review contractors may be participating in the esMD pilot beginning on or before December 2011:

  • The RAC for region C
  • The MACs for jurisdictions 2, 6, 7, 8, 11
  • The durable medical equipment (DME) MACs for jurisdictions A, B, C and D

In order to participate in the pilot of the esMD program providers will need to utilize a gateway for information exchange. The Nationwide Health Information Network (NHIN) is set of standards, protocols, legal agreements and specifications that a consortium of health information organizations have agreed are necessary for secure and private exchange of health information over the Internet, according to CMS. The Nationwide Health Information Network Exchange is designed to "connect a diverse set of federal agencies and private organizations to securely exchange health information," and CMS intends to use it during the esMD pilot.

Within this information network are gateways, which are necessary in order take part in the esMD pilot, according to Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.

"Providers will need to obtain access to a CONNECT-compatible gateway," she says. "While hospitals may choose to build their own gateway, CMS anticipates that contracting with a health information handler (HIH) that offers esMD gateway services will be the most popular choice."

While this new development aims to help streamline internal processes, providers should consider a number of factors, according to Mackaman.

"First, providers should do a cost-benefit analysis of using esMD versus mailing paper or CDs," she says. "Facilities already have to absorb the expenses of the existing process since the current copy reimbursement rate of $0.12 per page does not cover the broad range of costs involved with processing even one request."

Healthcare providers may also want to consider waiting until CMS works out many of the initial bugs and process changes once the phase one option goes live, she adds.

For more details visit the esMD web site at http://www.cms.gov/ESMD.

Additionally, CMS published three frequently asked questions regarding esMD.

What is esMD?

How do we sign up for esMD?

Has CMS made any public presentations about esMD? Are slides/handouts available?

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