Beginning this month, some contractors are going to begin accepting Electronic Submission of Medical Documentation (esMD). Currently, the MAC, RAC, CERT, and PERM Contractors issue requests for records and the provider mails the paper copy of all the records to them for review. In an effort to reduce expenditures on paper and postage, these entities will begin accepting the records electronically. By October 2012, the entire process is expected to be completely electronic, meaning that even the request for records from the contractors will be received electronically by the provider.

Some facts are as follows:

  • CMS built an Exchange Gateway to accept esMD transactions from providers
  • esMD is NOT mandatory
  • A provider must utilize their own CONNECT-Compatible Gateway or contract with an HIH (Health Information Handler) in order to transmit the records electronically
  • Most organizations will probably use an HIH, unless it is a very large organization such as a large hospital system that has a large IT department
  • There are a number of HIHs that plan to offer these services beginning this month and a larger number offering them beginning in Nov. 2011 and even more in Jan. 2012
  • CMS does not dictate how an HIH communicates with providers as long as they are HIPPA compliant
  • If utilizing an HIH, the provider would need to establish communication with the HIH on confirming receipt of the electronic record. CMS will confirm with the HIH that they have received the record on their end
  • If building your own Gateway, detailed information can be found in the esMD Implementation Guide at www.cms.gov/esMD
  • Current format accepted through the Exchange Gateway is in a PDF.  Plan is to expand the formats accepted including structured orders, notes, etc.
  • CGI, Ohio's Medicare Recovery Contractor (RAC), will begin accepting esMDs this month
  • CIGNA Government Services (CGS), Ohio's Part B and future Part A MAC, will begin accepting esMDs beginning January of 2012

For more information re: this process and how to implement, please visit www.cms.gov/esMD . You may also contact anyone on the esMD Team at esMDTeam@qssinc.com. To learn more about how HealthPro Rehabilitation can help, contact Sheri Tomlinson at HealthPro Rehabilitation, stomlinson@healthpro-rehab.com.

Kate Davis is the director of business development at HealthPro Rehabilitation and can be reached at kdavis@healthpro-rehab.com.