Audit and Compliance



In just a few short months, the RAC audit program is expected to kick back into action, running again at full capacity with RAC audit contractors now approved and their provider outreach programs underway. As Medicare providers prepare to transition back into audit response mode, an increasing number are now equipped to tackle the process in a more streamlined and efficient way through the esMD program offered by the Centers for Medicare & Medicaid (CMS).

The esMD program—which stands for Electronic Submission of Medical Documentation—enables Medicare providers to respond to both Medical Documentation and Prior Authorization Requests electronically. This process can reduce the time for response activities by several days, with esMD submissions taking an average of just a few hours to receive confirmation of receipt.

Those efficiencies have attracted tens of thousands of Medicare providers to the program and driven exponential growth in participation, according to the latest statistics released by CMS.

  • Nearly 40,000 Medicare providers participated in the program during the first half of fiscal year 2015.
  • 320,154 Medical Records were transmitted during the program's first 15 months (through March 2013).
  • 1.72 million Medical Records were transmitted through March 2016, marking growth of more than 500%.

Notable is that much of this growth took place during a time when most providers were enjoying some relief from the RAC audit process due to the RAC Program hiatus. This proved to be an ideal time for providers to transition to this new process.

Once RAC activities resume in earnest, providers will once again be faced with the burden of responding to large-volume records requests (with limits up to 450 records every 45 days), placing a strain on hospital staff resources. For many providers, managing the physical correspondence process is not possible without hiring additional resources to pull, copy and mail records to the auditors. This manual process is cumbersome and lengthy, taking up to several days to complete.

Through participation in the esMD program, providers can avoid this hassle. Working with the right certified Health Information Handler (HIH) to implement a solution can enable an audit response process that is almost completely automated. Implementing a tool with integrated esMD services can help control costs while providing a fast, secure and transparent submission process.