esMD

Challenge

CMS and other appropriate payers need a standardized, implementable, machine-interoperable electronic solution to reduce the time, expense, and paper required in current manual processing of both medical documentation request letters and the relevant claims attachments exchanged between providers to payers. To support the electronic sending of medical document request letters and the electronic submission of medical documentation, the following solutions will be required:

• Standardized Electronic template to be used for medical document request letters
• Process for Provider Registration with CMS to receive electronic request letters
• Secure sending of the medical document request letters to registered providers
• Verifiable alternative for wet signatures on electronic medical documentation: a method of verifying the origin and authenticity of data submitted to CMS for payment determination
• Standardized structured content for claims attachments*

The purpose of the esMD initiative is to enable the electronic sending of medical document request letters to providers, and identify author-level signature solutions needed to enable acceptance of electronic claims attachments. These goals will be addressed in multiple phases, aligned with CMS esMD Implementation objectives. The  esMD Phase 2 goals are to develop simplified mechanisms to electronically send medical document request letters to providers. To support acceptance of structured claims attachments from providers to CMS (future esMD phase), the esMD Initiative will also develop solutions to enable signing of content records that can be trusted by CMS or other valid recipients, replacing the currently-used paper or scanned wet signatures.

The Electronic Submission of Medical Documentation (esMD) Initiative intends to replace current paper processes for medical documentation requests and claims attachments with an electronic alternative. This initiative was begun to provide solutions that address gaps raised by CMS post-payment reviews specifically; however, through the participation of other relevant stakeholders, the outputs of this initiative will reflect the requirements of other payers, providers, and additional relevant stakeholders.

* Structured Content for claims attachments is currently out of scope for the esMD Initiative, but is a long-term esMD objective, and may be addressed following the completion of other esMD priorities.