Information for Providers

In order to participate in the Electronic Submission Medical Documentation (esMD) pilot, providers must do two things: 

  1. Find out if your Review Contractors accept esMD transactions
  2. Obtain access to an esMD gateway

To obtain access to a gateway, providers can either: 

  1. Build their own
  2. Hire a Health Information Handler (HIH) 

To view a list of participating HIHs, visit the esMD "Which HIHs Offer esMD Gateway Services to Providers?" page. Providers (physicians, hospitals, etc.) must obtain access to a CONNECT-compatible gateway. Although some large providers, such as hospital chains, may choose to build their own gateway, the Centers for Medicare & Medicaid Services (CMS) anticipates that many providers will choose to obtain gateway services by entering into contract or other arrangement with an HIH that offers esMD gateway services.

More information can be found in the presentation "Introducing esMD to Providers, RCs, and HIHs" in the 'Downloads' section below.

Frequently Asked Questions:

How do I electronically send or receive Additional Documentation Letters (ADR)?

The Electronic Submission of Medical Documentation (esMD) system allows:

  • Providers and Health Information Handlers (HIHs) to electronically send their responses to ADR letters to review contractors during the claims review process
  • Review contractors to electronically receive responses to ADR letters sent by providers and HIHs during the claims review process

For more information on the benefits of esMD and how to join, please view the PowerPoint titled “Introducing esMD to Providers, RCs, and HIHs 2015” in the 'Downloads' section below. Furthermore, view the Program Integrity Manual section – “Additional Documentation Request Required and Optional Elements” (PDF) in addition to the associated Program Integrity Manual Exhibits 46.1 – 46.5 (PDF). Also, view the esMD web pages listed on the navigation menu on the upper left hand side of this page.

Will providers get more Recovery Auditor medical documentation requests if they respond quickly?  For example, if a provider submits requested documentation in 20 days, will this cause the Recovery Auditor to “restart the clock” earlier for the next round of medical documentation requests?  

No. The CMS allows Recovery Auditors to issue documentation requests every 45 days. This equates to 8 times a year. When medical documentation is received by the Recovery Auditor, this does not change the 45 day period for when Recovery Auditor could issue the next documentation request. The purpose of the 45 days is so that providers do not have several open documentation requests at one time.

Are providers required to electronically submit medical documentation?

Providers should keep in mind that esMD is completely voluntary. Providers who are content with faxing or mailing documentation to their Medicare Review Contractor may continue to do so. However, providers who believe it would be more efficient to respond to documentation requests electronically are encouraged to contact one or more of the HIHs to determine if esMD services are available to the provider for a reasonable price.

Which HIHs Currently Offer esMD gateway services?

To see which HIHs currently offer esMD gateway services, visit the esMD "Which HIHs Offer esMD Gateway Services to Providers?" page.

In addition to contacting the HIHs that have already built an esMD gateway, providers are encouraged to contact HIHs with whom they already have relationships (e.g., claim clearinghouses, release of information vendor, Health Information Exchange) to identify HIHs who are planning to build an esMD gateway in the near future.

Which brand of Electronic Health Record must I have to use esMD?

The esMD allows for the submission of Portable Document Format files. Therefore, any Electronic Health Record system that is capable of exporting health information as a PDF file can be submitted via an esMD gateway.

Are providers still using paper records excluded from using esMD?

Providers who have paper records may utilize esMD services so long as they have a mechanism to scan the paper records into a PDF file. Some esMD HIHs specialize in this kind of service.

Will providers who use esMD be more likely to get selected for review?

No. The CMS prohibits review contractors from selecting providers based on their esMD status (CMS Program Integrity Manual, Chapter 3, Section 3.2.1).

What date will the Review Contractors use as a receipt date for esMD submissions?

The Medicare Administrative Contractors (MACs) shall use the esMD Enterprise File Transfer (EFT) system receipt date as the date the documentation was received. For more information on the receipt date refer to Transmittal R426PI (PDF).

Page Last Modified:
11/15/2016 04:19 PM