Skip over navigation

Electronic Submission of Medical Documentation (esMD)

Each year, Medicare makes billions of dollars in estimated improper payments. CMS employs several types of Review Contractors to measure, prevent, identify, and correct these improper payments.

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.

CMS eHealth initiative aligns health information technology (Health IT) and electronic standards programs. The eHealth programs will help improve the health care system including reducing provider paperwork through administrative simplification.

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

The primary intent of esMD is to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors. A secondary goal of esMD is to reduce costs and time at review contractors. In order to send medical documentation electronically to review contractors, Medicare Part A providers must obtain access to a CONNECT-compatible gateway.

  • Certain larger providers, such as hospital chains, may choose to build their own gateway.
  • Many providers may choose to obtain gateway services by entering into a contract or other arrangement with a Health Information Handler (HIH) that offers esMD gateway services.

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 the future.

Which Review Contractors Accept esMD Transactions? This link takes you to an external website. - The listing is updated with HIHs that have been approved by CMS to offer esMD services. CMS and Noridian do not set the price that an HIH may charge a provider for esMD services. Providers who believe it may be more efficient to respond to documentation requests electronically are encouraged to contact one or more of the HIHs to determine if esMD services are available at a reasonable price. esMD is completely voluntary. You may continue to mail or fax documentation to Noridian. Additionally, neither CMS nor Noridian will provide reimbursement for any cost or fees for esMD.

Noridian recommends that documents are submitted in a searchable content capable PDF format.

Resources

 

Last Updated Aug 08, 2017