Provider Strategy

esMD: Your Secret Weapon

Program offers an electronic edge in doc requests.

• By Ellen Sluder
• Sep 01, 2015

You submit claims electronically. You get payments electronically. You store patient records electronically. Why are you still submitting paper for requests such as audits, PMD prior authorization and appeals? Did you know CMS offers a way to electronically submit documentation?

The traditional submission methods of fax or mail duplicate effort and waste resources by taking medical documentation that is stored electronically and forcing it to be printed, only to be re-scanned once it’s received by the Review Contractor. Most importantly, it stretches out the payment cycle and potentially puts your payment at risk. It creates a heavy burden on you as a provider to follow up and ensure you get the money you have earned.

There is an easy, hassle-free and transparent way to respond to medical documentation requests, and get faster payment: Electronic Submission of Medical Documentation (esMD). CMS first implemented esMD in 2011 and it has grown in scope ever since. It also seems to be one of the best kept secrets in the industry.

What is esMD?

esMD provides a direct gateway to CMS and Review Contractors and enables you to track the status of your submission. It relies on an advanced communication network that uses the utmost in data security to maintain HIPAA compliance and ensure proper routing of all submissions. All of the work in preparing a submission can happen right at your desk, in just a few minutes time and you can track your success in an instant.

To submit with esMD you can sign up with a CMS certified Health Information Handler (HIH). CMS certifies technology providers as HIHs to properly package, transmit, and track submissions. HIHs participate voluntarily and receive no funding from CMS to participate in the program and build their technology. The cost of esMD varies by HIH, some operate a subscription model or charge per submission, and some bundle it in with other services they provide.

Review contractors must be able to receive electronic submissions and confirm receipt to providers. An up-to-date list of what types of submissions HIHs and Review Contractors are certified to send and receive is at www.cms.gov/esmd.

The present and future of esMD

In its current state, esMD allows for electronic documentation submission to Review Contractors, but requests still come to HMEs through paper mail. CMS continually works to expand the types of submissions that esMD can handle, recently adding Advance Determination of Medicare Coverage (ADMC) and Prior authorization for hyperbaric oxygen. There are some types of outbound communication from Review Contractors that go through the system, such as PMD Prior authorization responses.

The future vision for esMD includes having initial documentation requests sent electronically through a provider registry, creating a 100 percent electronic communication system. It is important to note that there are no plans to make esMD mandatory, although CMS hopes to make it such an attractive option that all providers begin to use it.

Benefits of esMD

Recently, HME Business hosted Faster Payments through CMS’s esMD, a free webinar sponsored by MedFORCE Technologies, in which Joyce Davis, deputy director of CMS’s Division of Compliance Projects and Demonstrations, discussed the history of esMD, the vision for the program’s future, and above all esMD’s clear advantages to providers:

Faster payment. Because communication is immediate from your desk, you save time in organizing, preparing, and sending packages. During the webinar CMS noted that a provider saw a documentation submission process that used to take three weeks from beginning to payment reduced to a mere 6 days.

Reduce denials due to timely filing. Using esMD, each submission is assigned a transaction ID number. In the event of a denial this can help prove that you made your submission timely. Using this ID, your HIH and CMS can work to reopen a case if the contractor incorrectly denied a claim for timeliness.

Track status. Sending documentation via mail or fax can feel like launching it into a black hole. With esMD, you get immediate feedback regarding your submission’s success. Also, you can track the full details of what you submitted, and with a click you can open and confirm the exact documentation sent.

Save money. The obvious cost savings of going paperless may come in several dollars at a time in saved paper and postage, but it can really add up over time. Where you save big is in the opportunity costs of having to follow up by phone to confirm receipt by the Review Contractor and verify completeness of submissions. With esMD, you can quickly check at any time of day, on your own schedule, and reallocate precious staff time to other activities.

Why aren’t more providers using esMD?

Every year, CMS appointed Review Contractors send over 2 million Medical Documentation Requests. The DME/HME sector is often disproportionately represented in those requests due to the intense documentation requirements for payment. With such obvious benefits, it can be quite surprising that a recent HME Business poll revealed that only 13 percent of respondents were using esMD.

To put is simply, esMD suffers from a major awareness problem. CMS doesn’t have large marketing budgets and relies on HIHs to reach providers and spread the word on esMD. MedFORCE Technologies was one of the first CMS-certified HIHs and participated in the beta development of the esMD gateway. Throughout our collective time in the healthcare industry we have seen the transition to electronic transactions across many different areas, such a claims and payments. In each case, the transition took time and needed to build the trust of providers before technology adoption rates increased. It is the same for esMD.

Now that there are several baseline years of success behind the esMD program, the statistics continue to improve. As of February 2015, over 80,000 healthcare providers across all sectors had signed up with an esMD HIH. As of April 2015 over 1.25 million medical records have been submitted through the CMS esMD gateway. These numbers keep climbing every day.

With CMS’s crack down on improper payments happening at the same time of changing regulations of ICD-10, providers need to cut as much waste out of their operations as possible. esMD is an important time and cost saving tool to streamline Review Contractor communications and empower your business.

This article originally appeared in the September 2015 issue of HME Business.