Medicare Compliance & Reimbursement

CMS wants to make your practice communications easier and more efficient, a new release suggests.

You will now have the option to receive the CMS additional documentation request (ADR) letter sent to you electronically versus in the mail. After repeated requests from Medicare providers to go digital, CMS decided to streamline its processes, the agency indicates in CR 11003.

Why? CMS successfully instituted a pilot program “supporting the electronic version of the ADR letter known as Electronic Medical Documentation Request (eMDR) via the esMD [Electronic Submission of Medical Documentation] system,” notes CR 11003. Keeping in line with its Patients-Over-Paperwork methodology, the new ADR delivery option will fast-track the data exchange timeline.

Caveat: The loss of protected health information (PHI) is still a worry, however, so eligible providers will have to send “a valid consent from the authorized individual representing the provider along with the destination details including any delegation to their associated or representing organizations such as Health Information Handlers (HIHs),” says CMS.

The agency is encouraging Medicare claims reviewers to jump on the eMDR bandwagon. Comprehensive Error Rate Testing (CERT) auditors and Quality Improvement Organizations (QIO) aren’t required to adopt the eMDR alternative, but “can opt to participate in the eMDR process” if they are inclined to, the release explains. Payment Error Rate Measurement contractors are exempt from using the new ADR delivery system.

Who and when: The release mentions “three registrations’ assumptions” that providers should take into account. Consider the following advice:

• Providers who sign up for the eMDR will receive both an electronic and mailed paper copy for the first three ADRs. The National Provider Identifier (NPI) attached to the billing provider will determine the ADRs sent.
• The eMDR registration is separate and not the same as provider’s enrollment in MAC portals and Direct Data Entry (DDE) (Part A).
• Once a provider bills under an NPI and agrees to the eMDR process, he or she “is applicable to receive eMDRs for all its Provider Transaction Access Numbers (PTANs),” according to the MLN Matters release.

CR 11003 is slated for implementation with a start date of July 1, 2019.

See the MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11003.pdf.