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melanie-combsThis month, some providers in some RAC regions will be able to submit medical record documentation electronically – and voluntarily – by way of the Electronic Submission of Medical Documentation (esMD), a pilot project that is scheduled to roll out Sept. 15, 2011 under the auspices of The Centers for Medicare & Medicaid Services.


Phase One of esMD will allow providers to electronically send medical documentation to Medicare Review Contractors. During Phase One, Review Contractors will continue to send medical documentation request via paper mail. Phase Two of the esMD pilot will allow Review Contractors to electronically send documentation requests to selected providers. Phase Two is scheduled to begin in October 2012.


Under esMD, providers will be able to reply to Review Contractors’ requests through secure electronic responses employing Nationwide Health Information Network (NHIN) standards.


Currently, Medicare Fee For Service Review Contractors request medical documentation from providers by a letter sent through regular mail. Providers have two options for submitting the requested records: by regular mail or by fax.


The Medicare fee-for-service (FFS) Program makes an estimated $36.3 billion in improper payments each year. CMS employs several types of Review Contractors to measure, prevent, identify, and help CMS correct these improper payments.


Review Contractors find the improper payments by selecting a sample of claims, requesting supporting medical documentation from the provider who submitted the claim, and manually reviewing the claim against the medical documentation to verify the provider’s compliance with Medicare’s rules.


About the Author


Melanie Combs-Dyer, RN, is Deputy Director, Provider Compliance Group, Office of Financial Management, Centers for Medicare & Medicaid Services. Melanie graduated from the University of Maryland School of Nursing and obtained her Masters Degree in Health Administration from Towson University.  Before joining CMS, Melanie worked as a registered nurse and as a medical record reviewer for the Maryland Peer Review Organization and for the Maryland Health Department.


Melanie has over 20 years of experience at CMS and has been involved with many provider compliance efforts.  In her current position, Melanie oversees the Comprehensive Error Rate Testing Program, the Medicare Recovery Auditors, the medical review efforts at the Medicare Administrative Contractors and the new Electronic Submission of Medical Documentation pilot.


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