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Compliance Projects

Reducing Provider Burden  

Electronic Submission of Medical Documentation – esMD

On September 15, 2011, CMS implemented the esMD system which enables providers to send medical documentation to review contractors electronically. The system is Exchange compatible, based on standards developed by the Office of the National Coordinator (ONC) for Health Information Technology. Medicare providers and review contractors believe that using the esMD system results in cost savings and increased efficiencies. The esMD system may help improve the payment turnaround time and reduce the administrative burden associated with medical documentation requests and responses. For more information on esMD, click here.

 Electronic Medical Documentation Interoperability – EMDI

EMDI engages key healthcare stakeholders like hospital systems, physicians, and vendors in the advancement of interoperability-related sending and receiving of electronic medical records between hospitals, physicians, labs, and vendors. The primary focus of EMDI is Provider-to-Provider communications using the same or similar standards as the CMS esMD project. For more information on EMDI, click here.

 Education and Outreach

 Programs to Evaluate Payment Patterns Electronic Report – PEPPER

PEPPER is an electronic report that provides provider-specific Medicare data statistics for discharges/services vulnerable to improper payments. PEPPER cannot be used to identify the presence of payment errors, but it can be used as a guide for auditing and monitoring efforts to help providers identify and prevent payment errors. PEPPERs are sent to facilities such as Short-Term Hospitals, Long-Term Hospitals, Critical Access Hospitals, Hospices, Inpatient Rehabilitation Facilities, Partial Hospitalization Programs, Skilled Nursing Facilities, Inpatient Psychiatric Facilities, and Home Health Agencies. For more information on PEPPER, click here.

 Comparative Billing Report – CBR

A CBR is an educational tool that provides data on Medicare billing trends, allowing a health care provider to compare their billing practices to their peers in the same state and across the nation. A CBR educates providers about Medicare’s coverage, coding, and billing rules, provides educational resources, and acts as a self-audit tool for providers. For more information on CBR, click here.

 Provider Compliance Tips

Provider Compliance Tips serve as a quick reference fact sheet to educate and provide high-level guidance to providers about claim denial issues and provide claim submission and documentation guidance. The tips cover Part A, B, and DME services with high Medicare improper payment rates. These tips are posted to the Medicare Learning Network and they are updated annually. For more information on Provider Compliance Tips, click here.

 Compliance Packets

Compliance Packets are comprehensive educational packets geared toward providers of certain Medicare services that have been identified as having high Medicare improper payment rates, and who require guidance with proper documentation. The compliance packet consist of the following: The Provider Compliance Tip; a short Informational Video, a Helpful Hints Document, and Letters to Provider Trade Associations. For more information on Compliance Packets see here.

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