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Health Care

Automate the Submission Process for Medicare Audits

AuditDocs conforms to NHIN submission standards

Published: Wednesday, September 21, 2011 - 16:34

Editor’s note: IVANS is providing a 30-minute webinar on Sept. 22, 2011, at 2 p.m. EDT, demonstrating AuditDocs. There is no cost to attend the webinar. Register here.

(IVANS: Stamford, CT) -- IVANS Inc. a national health information exchange, is offering AuditDocs to save health care providers time and money during Medicare audits. AuditDocs enables providers to quickly and securely submit medical documentation electronically for audits initiated by the Centers for Medicare and Medicaid Services (CMS) under the Electronic Submission of Medical Documentation (esMD) program.

Recognizing the need to provide a more efficient way to deliver medical records to the review contractor, the esMD program enables Medicare auditors, including recovery audit contractors, Medicare administrative contractors, comprehensive error rate testing, payment error rate measurement, and zone program integrity contractors to accept electronic attachments from providers.

Health care professionals generally fax or send paper to substantiate Medicare audits. Under the esMD program, providers can work with a CMS-approved health information handler, such as IVANS, which has developed a CONNECT-compatible gateway that conforms to Nationwide Health Information Network (NHIN) standards and leverages IVANS’ health information exchange platform. [CONNECT is the software that CMS is using to build its esMD gateway.]

“For years, we have worked closely with CMS to enable 500,000 providers secure, affordable access to Medicare for claims processing,” says Clare DeNicola, president and CEO of IVANS. “Now through our partnership on the esMD program, we are extending the support of our health care transactions on IVANS LIME HIE platform by providing a secure, electronic submission process that replaces costly and time-consuming methods.”

When a health care provider is notified of an audit, the provider has 45 days to submit medical records to substantiate the Medicare claim. Through IVANS AuditDocs, providers can send documents to review contractors electronically in real time instead of printing, packaging, and shipping thousands of pages of medical documentation to support their claims. AuditDocs also supports a robust dashboard for detailed tracking, so providers can monitor which documents have been sent and when they are received by the auditor. The solution includes document archiving to ensure documentation is readily available throughout the appeals process.

IVANS recently conducted a hospital survey which revealed that 73 percent of hospitals agree that the recovery audit contractor (RAC) program helps to reduce fraud and errors in the industry. However, more than 60 percent do not think the audit process is fair. According to IVANS 2011 RAC Audit Survey, respondents cited that the extra time and money it takes to substantiate a RAC claim is impacting budgets and resources that are already stretched too thin, and that the frequency (every 45 days) with which they can be audited is burdensome to their administrative workflow. The study also found 32 percent of hospitals surveyed have put tracking software in place, 21 percent have hired additional staff or external resources to respond to RAC audits, and 38 percent have modified claims admission criteria to reduce future denials.

“Many of our customers, including hospitals, [durable medical equipment] DMEs, and home health and skilled nursing facilities, are concerned with the time and financial impact required to meet tight deadlines,” says DeNicola. “As the CMS esMD initiative gets underway this month, I am confident that providers will not only enjoy this faster, less expensive method for responding to payment audits, but the health care industry will also embrace this program as an important step toward advancing the adoption of interoperable health IT systems and health information exchanges across the country.”


About The Author


IVANS Inc. provides the property and casualty insurance and
health care industries with fully managed network, electronic data
interchange, and agency-company interface solutions to help solve
complex business issues. Headquartered in Stamford, Connecticut, and a CMS-approved vendor, IVANS serves more than 4,400 insurance and health care
organizations, more than 30,000 independent agents, and 500,000
health care providers. It also offers customer service, security solutions, reliable and accessible technical
help-desk support, and expert enablement. IVANS, which was formed by 21
insurance companies, also has offices in Tampa, Florida, and Cincinnati,
Ohio. Visit IVANS health care blog, HealthWire, at www.ivans.com/healthblog.