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Creating an Electronic Submission Process for Medicare Review Contractors
The Centers for Medicare & Medicaid Services (CMS) estimates that the Medicare & Medicaid programs issue billions of dollars in improper payments each year. Most improper payments can only be detected through a manual process comparing a claim with the medical record. CMS Review Contractors such as Medicare Recovery Audit Contractors (RACs), the Comprehensive Error Rate Testing (CERT) Contractor, and Medicare Administrative Contractors (MACs) request and receive over one million medical records from providers each year. Providers respond to these requests for medical records by mailing or faxing the medical documentation to the Review Contractor.
The Electronic Submission of Medical Documentation (esMD) pilot will give providers a more efficient way to deliver medical records to the requesting contractor. esMD utilizes the technology of the Nationwide Health Information Network (NwHIN) , called CONNECT-compatible gateways, to keep the documentation secure as it moves from the provider to the requesting contractor.
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