CMS Research, Statistics, Data & Systems- Electronic Submission of Medical Documentation (esMD)
Guidance for CMS Research, Statistics, Data & Systems regarding the Electronic Submission of Medical Documentation (esMD).
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: August 03, 2020
The Medicare Fee-for-Service (FFS) Compliance programs prevent, reduce, and measure improper payments through medical review. We provide a number of programs to educate and support Medicare providers in understanding and applying Medicare FFS policies while reducing provider burden.
The Electronic Submission of Medical Documentation (esMD) system helps different entities eliminate the need to mail or fax paper documents. esMD allows:
Providers and suppliers to electronically submit medical documentation requested by the Centers for Medicare and Medicaid Services (CMS) for improper payment review and requests for prior authorization.
Review contractors (RCs) to submit Additional Document Requests (ADRs) to providers electronically.
RCs to exchange solicited documents with other CMS adjudicators electronically.
esMD reduces burden on providers and supports CMS’ broader eHealth Initiative.
Get Started with esMD
Providers can use esMD to submit documentation for the following Lines of Business (LOBs):
- Prior Authorization Requests for Hospital Outpatient Department (OPD)
- Prior Authorization (PA) Requests for Repetitive Scheduled Non-Emergent Ambulance Transport
- Review Choice Demonstration for Home Health Services
- Response to Additional Document Requests (ADR)
- Supporting Documentation for PA Request
- Paperwork (PWK) Unsolicited documents
- First and Second Level Appeal Requests
- Advanced Determination of Medicare Coverage Requests (ADMC)
- Durable Medical Equipment (DME) Phone Discussion Requests
Suppliers can use esMD to submit documentation for the following LOBs:
- PA Requests for Durable Medical Equipment, Prosthetics/Orthotics & Supplies (DMEPOS)
- Durable Medical Equipment (DME) Phone Discussion Requests
RCs can use esMD to request information for the following LOBs:
- Requested documents to other CMS adjudicators
- Pre-Pay and Post-Pay Electronic Medical Documentation Request (eMDR) letters
Refer to Introducing esMD to New Providers RCs and HIHs (PDF) for benefits and other details.
Current Release Documents
The esMD technical team distributes the following documents for RCs and Health Information Handlers (HIHs) during the course of the release:
- Release Summary Document
- The RC/HIH Initial Technical Release Change Document
- The RC/HIH Final Technical Release Change Document
Visit esMD for Health Information Handlers and esMD For Review Contractors for the most current versions of these documents.
Future Functionalities
To align with the Centers for Medicare and Medicaid Services' (CMS) move of most of its Enterprise architecture to the Amazon Web Service (AWS) Cloud environment, esMD is planning to onboard the HIHs and RCs onto the AWS Cloud environment in a phased approach starting from the July 2022 release. This onboarding process will continue until all the HIHs and RCs are fully onboarded by the end goal of 2023.
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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.