CMS Electronic Submission of Medical Documentation (ESMD)
Investment ID: 009-000462748
Overview
Program Title
CMS Electronic Submission of Medical Documentation (ESMD)
Description
The Medicare FFS Program pays billions in improper payments each year. CMS employs several types of Review Contractors (RC) to prevent and to identify, measure, and correct these improper payments. The RCs identify the improper payments by selecting a small sample of claims, requesting supporting medical documentation from the providers who submitted the claims, and manually reviewing the claims against the medical documentation to verify the providers compliance with Medicare rules. The Electronic Submission of Medical Documentation (esMD) system is a web portal that facilitates the secure exchange of medical documentation between providers and RCs. Additionally, the esMD system utilizes the standards developed by the Office of the National Coordinator (ONC) for Health Information Technology (HIT).
Type of Program
Major IT Investments
Multi-Agency Category
Electronic Records Management
Investment Detail
The esMD system supports the CMS strategic goal to improve health care and population health through the meaningful use of health information technology. The esMD system also increases the electronic exchange of medical documentation resulting in administration simplification/paperwork reduction and reducing improper payment rates. Based on calculations related to the reduction of paperwork, the use of esMD results in postage and resource savings i.e. reduction/elimination of document imaging, mail room related costs and storage facility expenses estimated at $34.52 per transaction. esMD also contributes to achieving CMSs strategic goal of healthcare fraud and abuse control by assisting with the measurement, prevention, identification and correction of Medicare improper payments. The performance measure results associated with this alignment are used to track the total Medicare trust fund dollars that are protected and/or recovered. To measure, prevent, and correct improper payments, CMS employs Medicare Review Contractors to compare the claims submitted by providers against actual medical documents. In order to identify or prevent improper payments, the Medicare RCs request medical records from providers via Additional Documentation Request Letters. The esMD system simplifies the exchange of medical documentation between providers and RCs by providing an electronic alternative for ADR responses.
Automation of eMDR registration and any corresponding with esMD support. The CR resulted in esMD receiving and processing the eMDR Registered Provider File, which contain the latest eMDR registered status of the providers who have registered to receive eMDRs. The eMDR registered provider file is the first step required to exchange ADR letters to Providers via the esMD system. Additional CRs to implement the exchange of pre-pay and post-pay ADR letters to registered Providers via the esMD.
Automation of eMDR registration and any corresponding with esMD support. The CR resulted in esMD receiving and processing the eMDR Registered Provider File, which contain the latest eMDR registered status of the providers who have registered to receive eMDRs. The eMDR registered provider file is the first step required to exchange ADR letters to Providers via the esMD system. Additional CRs to implement the exchange of pre-pay and post-pay ADR letters to registered Providers via the esMD.