Progress in esMD Electronic Submission Project

Healthcare providers facing a claims audit by the Centers for Medicare and Medicaid Services are a step closer to submitting their documents electronically. The first live record has been successfully sent in a CMS pilot project.

CMS’ electronic submission of medical documentation (esMD) project will allow providers audited by the RACs, MACs, PERMs, Z-PICs, and other CMS programs to transmit requested documents electronically over the Internet using secure Nationwide Health Information Network (NwHIN) Connect protocol.

Currently providers must mail or fax printed copies of auditor-requested records. Once received, the paper documents are scanned into an electronic system and destroyed—a waste of paper, mailing costs, and labor.

Once esMD is fully operational, providers can electronically submit auditor-requested documents to an official health information handler (HIH) organization that has developed an esMD gateway using NwHIN Connect protocol.

The HIHs—which include claim clearinghouses, release of information vendors, health information exchanges, and EHR vendors—will use the esMD gateway to electronically send provider documents to a CMS repository where CMS review contractors can access the documents for an audit. Organizations can develop their own esMD gateways, though the development cost means most providers likely will contract with an HIH.

CMS developed esMD to speed up the auditing process and save time and resources. The project also serves as CMS’s first initiative using the developing NwHIN Connect system.

While HIHs can’t officially claim to be on the NwHIN due to legal restrictions, the gateways are designed using the NwHIN protocol and software. Currently only official federal contractors can be listed as using the NwHIN Connect platform, a technicality that is set to change as early as summer 2012.

Not Ready for Rush Hour

Release of information vendor HealthPort, one of several HIHs working with CMS, successfully transmitted the first medical records using the esMD gateway in September, according to Steve Emery, director of product management at HealthPort.

Because the submission process is new, HealthPort and other HIHs expect to ease into esMD transmissions. HealthPort plans to spend several months testing esMD with select pilot providers before opening up the service to the general public, Emery said.

Emery likens the esMD development process to building an interconnected highway system. Right now, construction is still ongoing.

“The highway is up, but it might be missing some guard rails and some of the on and off ramps aren’t complete,” Emery said. “We can send some cars through there, but we probably don’t want to run rush hour traffic through there just yet.”

Processes for handling transmission failures and mistakes still need to be worked out before the program is ready for mass use.

“Our next step is to pass just a handful of requests through on a pilot basis so that everyone gets used to traveling over it, but not so much traffic that if something went wrong it would be a real issue to deal with,” Emery said.

Providers audited by CMS will not be required to use esMD to submit requested documentation, according to CMS. Paper mailing processes will still be accepted.

For the first stage of the project, esMD participating providers will continue to receive paper audit requests through the mail from CMS contractors. When phase two of esMD begins in October 2012, CMS contractors will electronically send documentation requests to providers through the esMD gateways when their claims are selected for review.

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