Medforce Blog

Q&A with CMS about esMD

July 28, 2015

Category: General

 

 

 

MedFORCE is one of the original CMS-certified Health Information Handlers (HIH). We helped CMS test and build the Electronic Submission of Medical Documentation (esMD) gateway which allows providers to respond to documentation requests and request prior authorizations.

In June, we sponsored a webinar featuring CMS discussing the history and future of esMD. It’s not only a great tool for shortening the payment cycle, it provides you with the tracking and accountability that is missing from traditional paper methods of communication.  In addition to CMS discussing the esMD gateway, we demonstrated MedFORCE’s ZipMit esMD product. You can watch and listen to the whole webinar on our website, in the Library section. If you’d like an individual live demo, please let us know by signing up through this online form or by emailing at sales@medforcetech.com.

The presentation portion was over in just over a half hour so we had plenty of time for a Q&A session. It’s always informative for us to hear the kinds of questions that come to viewers’ minds. And, we thought it might be useful for others to learn from the group.

Here is a summary of the top questions and answers from our esMD webinar, answered by CMS and by MedFORCE.

Q: What kind of time difference does esMD promise as opposed to traditional methods like faxing?

CMS: We have had a provider tell us that, from beginning to end, it used to be 3 weeks to see payment when documentation was submitted by fax or mail. They have noted by using esMD the turnaround time is 6 days.

MedFORCE: It doesn’t speed up the time that the review contractor takes. But it does save a lot of time and cost in various ways. Because the communication is immediate, from your desk, there is time and money saved in organizing, preparing, and sending packages. You save money in paper costs, in postage, and in your time by the no delay in receipt by a RC and not having to constantly follow up to make sure your documentation has been received complete.

 

Q. Why are providers so slow to uptake this program? Seems like a slam dunk.

CMS: We think the issue is getting the word out. A lot of people haven’t heard of esMD yet. That’s why we encourage the HIHs to reach out to providers and we do presentations like this. It’s more awareness than anything.

MedFORCE: We have some clients who like to hold onto their paper. It’s what they are used to. In those cases, it’s about us educating them that this is easier, faster and very secure.

 

Q: Is there a list of approved Health Information Handlers (HIHs) and Review Contractors who use esMD?

CMS: Yes, there are lists for both available at our website at www.cms.gov/esmd . This is the definitive spot to get the most up-to-date lists.

 

Q. If a provider signs up for esMD and then they have an issue with it, who should they call? CMS or their HIH?

MedFORCE: If you sign up with MedFORCE, we always prefer that you call us first. We can help drill down to what the issue might be, and we can loop in CMS if we need to.

 

Q: What is the volume of submissions that you are seeing providers submit through esMD? Is there a typical amount?

MedFORCE: It really depends on the size of the provider. Some of our clients submit 5 or 10 a month, some of our larger clients send over 2,000 a month. It depends on the type of business.

CMS: We don’t know how the 2 million requests for additional documentation [by the review contractors] are going to be targeted. You just never know.

 

Q: Does using esMD guarantee payments for audits and claims?

CMS: esMD is intended for following up on documentation requests, not for submitting claims. It is a way to submit documentation. We don’t guarantee anything regarding payment. If your documentation is correct and as it needs to be, you will be paid the same whether you use esMD, fax or mail.  When providers submit documentation through an HIH, there is a great tracking system. We can see if a document has really been received. We can use the transaction date as your confirmed date.

 

Q: If esMD is used to submit audit documentation and follow up on documentation requests, are providers able to use esMD to check the status of the audit through the Medicare system?

CMS: No. Right now, they can’t actually use the system to check the status, only to track the submission of the documentation. But that is something we’re looking into for upgrades to our system – the ability to check the status of pills, codes, review results and check the status of a claim.

 

Q: Will CMS be expanding opportunities for prior authorization through esMD for other types of DME?

CMS: Yes, we are thinking about it. Currently we are expanding to use HBO (hyperbaric oxygen therapy) and non-emergent ambulance. We’re excited about that. And we see as we are adding these kinds of prior authorizations, our system will grow.

 

Q: Is signing up with an HIH mandatory?

CMS: esMD is not mandatory. It is for those providers who are already using some type of EHR system and want to stay electronic. It saves them from having to print everything – just to have the review contractor scan it in again when they receive it.

MedFORCE: No, but it makes the process a lot easier.

 

Q: How does the pricing work? Does MedFORCE offer a per-use option or require a subscription?

MedFORCE: We offer a lot of different options because each provider’s needs are different. Typically, it’s a monthly fee for a set number of submissions and after that, it’s a per submission fee. We’ll work with providers to create  a package that works for them, and we can also bundle with our other services.

 

Q: Is it a requirement that you sign up with MedFORCE’s document management to use ZipMit?

MedFORCE: No it is not a requirement. You can use ZipMit with your current EMR or EHR or however else you manage your documents.

 

Q: Is there a fee to HIHs to use esMD? Does the service itself have a cost?

CMS: All of our HIHs charge a different type of fee. It’s not free because the HIHs went through an extensive 6-8 month certification process in order to be able to do esMD, and it cost them a lot of money.

MedFORCE: Even after we were certified, we had to develop our own product. They did not give us a product. And we continue to support it, expand it and improve it. We regularly meet with CMS and other HIHs to provide feedback and improve the system.

 

Q: What’s the best way to get started? What would you advise providers to do?

MedFORCE: It’s actually very simple and can be done in one day. Just let us know you want to start. Our Tech Support provides you with a URL and gives you user names and logins for unique users. Then our Training staff will teach you through how to submit documentation – we do it through an online meeting.  We walk you through how to use the product and make a submission, give you a user handbook, and our Tech Support is always available for questions. As new people get hired, we’d be happy to train them as well for you.

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