The Centers for Medicare and Medicaid Services (CMS) has authorized several audit programs to mitigate the impact of improper payments made to healthcare providers. Each audit involves an Additional Documentation Request (ADR) in which healthcare providers must submit medical records used to substantiate Medicare claims. Given the challenging time constraints and significant financial costs of an ADR, long-term care and assisted living providers must be prepared to respond efficiently.
Recognizing the need to provide a more efficient way to deliver medical records to the review contractor, the esMD Program was created so Medicare auditors, including RACs (Recovery Audit Contractors), MACs (Medicare Administrative Contractors), CERT (Comprehensive Error Rate Testing), PERM (Payment Error Rate Measurement) and ZPICs (Zone Program Integrity Contractors) can accept electronic medical records from providers.
Healthcare professionals generally fax or send paper to substantiate Medicare audits today. Under the esMD Program, long-term care and assisted living providers can work with a CMS-approved Health Information Handler (HIH), such as IVANS, which has developed a CONNECT-compatible gateway that conforms to Nationwide Health Information Network (NHIN) standards and leverages IVANS health information exchange (HIE) platform.
Using Technology to Eliminate Paper, Save Time and Money
For over 15 years, IVANS has been working closely with CMS to give 500,000 providers secure, affordable access to Medicare for claims processing. IVANS new solution, AuditDocsSM, interfaces with the CMS esMD program, enabling providers to quickly and securely submit and track medical documentation electronically. Through this application, providers can send documents to review contractors in real-time instead of printing, packaging and shipping thousands of pages of medical documentation to support their claims during recovery audits.
IVANS AuditDocs offers a robust dashboard for detailed tracking, so providers can monitor which documents have been sent and received by the auditor. Through our partnership with CMS and by expanding our compliance solutions on our HIE platform, we are able to offer a secure, electronic submission process that will save long-term care and assisted living providers considerable time and money during recovery audits.
RAC Survey Helps to Reduce Fraud and Errors
IVANS recently conducted a hospital survey which revealed that 73 percent of hospitals agree that the Recovery Audit Contractor (RAC) Program helps to reduce fraud and errors in the industry. However, more than 60 percent do not think the audit process is fair. According to IVANS 2011 RAC Audit Survey, respondents cited that the extra time and money it takes to substantiate a RAC claim is impacting budgets and resources that are already stretched too thin, and that the frequency (every 45 days) with which they can be audited is burdensome to their administrative workflow. The study also found 32 percent of hospitals surveyed have put tracking software in place, 21 percent have hired additional staff or external resources to respond to RAC audits, and 38 percent have modified claims admission criteria to reduce future denials.
Many long-term care and assisted living providers have told me they are concerned with the risk and financial implications associated with meeting tight deadlines. I am confident that the esMD initiative, which kicked off September 15, 2011, will enable providers to enjoy a faster, less expensive method for responding to recovery audits. Additionally, I believe the industry will embrace this program as an important step toward advancing the adoption of interoperable health IT systems and health information exchanges across the country.
Michael Schramm is the vice president of product and innovation in IVANS healthcare business unit.