CMS esMD software for Health Information Handlers in Virginia

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A project developed by CMS called the Electronic Submission of Medical Documentation (esMD) provides an automated mechanism for managing the claims request and submission process through secure electronic communication between contractors and providers. The esMD program allows providers who either are or contract with Health Information Handlers (HIHs) to receive document requests and submit required medical records and associated documentation electronically during the claims review process. Discussion Letters, as well as Level 1 and Level 2 Appeals, can also be submitted electronically. Phase 1 of the esMD program launched in September 2011, enabling providers to respond to Additional Documentation Request (ADR) letters and contractors to receive the requested medical documentation electronically. Phase 2 of the esMD program went live in March of 2020, debuting new features that enable bidirectional communication between providers and review contractors. Bluemark refers to the combined Phase 1 and Phase 2 process as “Full Cycle” esMD

The esMD program can reduce the overall time for response activities by several days and provides tremendous value to the provider community through:

• Overall process efficiencies
• Improved accuracy
• Reduced administrative burden and cost
• Significantly expedited claims review process Key Features of the esMD Program

Since the launch of Phase 1, the esMD program has consistently expanded to include new features and functionality. The program started with the electronic submission of medical records and documentation and with Phase 2, it introduces new electronic communication features that further streamline the claims review process. These new features allow review contractors to send electronic documentation requests (eMDRs) and other forms of communication to providers, establishing the structure for an almost completely paperless audit response process.

Benefits of eMDR

Eliminating traditional methods of document receipt and submission dramatically shortens the time it takes to respond to audit requests, which can lead to faster decisions by auditors, accelerated appeals, and faster payment adjustments. To best understand the impact provided by the new Phase 2 functionality, the eMDR transaction, let’s start out by reviewing today’s typical process for the provider. The details of this part of the process can differ from provider to provider. Here we are outlining the typical steps an ADR will go through to begin the audit response process.

1. Audit is initiated by the contractor, and the audit document request letter is mailed to the
2. ADR Letter navigates through the S. Postal Service and gets to the provider’s facility in two to three business days.
3. The ADR letter moves through an internal mail process to reach the appropriate audit management resource.
4. Staff reads the letter and accesses the audit tracking tool or spreadsheet to initiate the response
5. ADR Letter is scanned into the tracking tool or saved
6. Data elements for requested claims are entered into a tracking tool or spreadsheet.