Each year the Medicare program 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.
Currently, Review Contractors request medical documentation by sending a paper letter to the provider. These providers usually have only 2 options for submitting the requested records: post mail; or send in via facsimile.
CMS intends to give providers a new mechanism for submitting medical documentation. CMS calls this new mechanism the Electronic Submission of Medical Documentation (esMD) pilot.
During Phase 1 of esMD, Review Contractors will continue to send medical documentation requests via post mail and providers will have the option to electronically send medical documentation to the Review Contractor that requested it. CMS plans to go live with esMD Phase 1 in April 2011.
During Phase 2 of esMD, Review Contractors will electronically send documentation requests to providers when their claims are selected for review. CMS hopes to go live with esMD Phase 2 in 2012.
Watch for more information on the esMD system in upcoming HCP Forum articles.