Full Cycle esMD

Streamline the Audit Response Process through Full Cycle esMD

Full Cycle esMD from Bluemark complements your audit management tools and processes for Medicare Contractor Audits with electronic document requests and electronic document submissions through the esMD System.

Simplified Audit Response

Tracking medical record requests and keeping up with all of the required documentation and processes in today's audit arena is extremely cumbersome. Recent Medicare Fee-For-Service audit program changes have created opportunities for providers to achieve efficiencies, specifically in the Release of Information process. Whether you are outsourcing the process to an ROI vendor or handling the process in-house, the cost can be high from both an administrative and financial perspective.

Despite the lower ADR limits now in place, providers are still burdened with the onerous process of tracking record requests and responding to all the required and supporting documentation for the audit process. Why stress the resources of your organization when you can simplify this process and take more control of your audit response by utilizing CMS' esMD program? Recent program enhancements now include the ability to receive additional document request notifications electronically.

What is Full Cycle esMD?

esMD is a program developed by the Centers for Medicare & Medicaid Services that allows providers and Certified Health Information Handlers (HIHs) to electronically transmit required documentation during the claims review process. Phase 1 of the program, launched in 2011 enables the electronic submission of Medical Records, Discussion Letters, as well as Level 1 and Level 2 Appeals. Phase 2 of the program, launching in early 2020 allows providers and HIHs to receive electronic versions of the Medical Documentation Request, referred to as eMDR. The esMD program is the preferred method for providers to manage the audit process by the Medicare Review Contractor community.

Bluemark developed Full Cycle esMD to take advantage of the bi-directional electronic document communication between the Recovery Contractors and Medicare providers. Full Cycle esMD creates a virtual in-box for electronic document requests and triggers the audit response process. Document submission is as easy as uploading a file and pressing submit. With Full Cycle esMD providers can easily and efficiently respond to all types of Medicare audits. Full Cycle esMD is available in both the Blueway Tracker comprehensive audit management solution and the Blueway Portal audit response solution.

Benefits to Providers

  • Simplify the Audit Response Process. Medical Documentation Requests are received electronically and the audit response workflow is initiated. No need to track down ADR notification letters and manually enter audit details into a tracking system.
  • Quicker Payment Turnaround Time. With esMD, providers have reported payment turnaround times of six days as opposed to three weeks with paper based submission processes. Also notable, Bluemark clients have reported an average turnaround time of 44 minutes from submission of documentation to receipt of Level 2 acknowledgement.
  • Reduced Costs. Full Cycle esMD eliminates the need to manually track and manage audit response activity, print medical records, and mail paper, feed a fax machine or burn CDs, reducing the labor required to fulfill documentation requests. Time savings can be as much as 50% per audit response. Full Cycle esMD also eliminates the hard costs of shipping and handling.
  • Peace of Mind. Full Cycle esMD provides a secure platform and a transparent process that facilitates almost-immediate feedback and issues notifications. A fully electronic process also eliminates potential data entry errors.
Utilizing the esMD platform is CMS' preferred method of audit document delivery.

Key Features

  • Secure web-based tool. Allows providers to securely transmit and receive sensitive audit-related data via the CMS Connect Gateway. Blueway meets all HIPAA and HL7 standards.
  • Automated Creation of Audit Response. Once the electronic medical document request is received in the eMDR Manager, the audit response process can be initiated. Multiple triggers to alert case managers that a new request has been received and loaded including a real-time dashboard and email notifications. From there, relevant data elements are input into appropriate fields and new requests populate a worklist for review and follow-on processing.
  • Electronic document submission capabilities for all records requests. Send Medical Records, Discussion Requests, and Level 1 and Level 2 Appeal Letters to any esMD subscribing contractor.
  • Activity dashboards. Featured on the user's home page, the dashboard provides a summary of all account activity, including new document requests, inventory status and data trends by both document and contractor types, as well as a complete list of activities due within the week.
  • Notifications and reminders. Users can opt to receive daily email summaries of activities due, to ensure no missed deadlines.

Blueway Family of Solutions

Full Cycle esMD is available within Bluemark's Blueway family of audit management and response technology. Blueway Tracker provides all of the necessary tools to assist providers in efficiently managing and responding to Medicare, Medicaid, and Commercial Insurance audits. Blueway Portal is one of the few standalone esMD solutions available today and allows providers to immediately begin taking advantage of Full Cycle esMD.

Click here for more information on Blueway Tracker.

Click here for more information on Blueway Portal.