IVANS AuditDocs Saving Healthcare Providers Hundreds of Hours By Automating the Process For Submitting Medical Documents During Medicare Audits

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IVANS submitting more than 6,000 pages electronically via the CMS esMD gateway.

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Vicky MacKay, patients accounts manager of Cottage Hospital said, "IVANS AuditDocs makes it easy to quickly respond to an audit request from our desktop and we have peace of mind that the submission process is adhering to all CMS guidelines."

With the majority of Medicare Jurisdictions in the United States already participating in the Centers for Medicare and Medicaid Services (CMS) Electronic Submission of Medical Documentation (esMD) program, more healthcare providers are now turning to IVANS AuditDocs to save them hundreds of dollars and hours during Medicare audits. Using AuditDocs via IVANS LIME® Health Information Exchange (HIE) platform, providers can quickly and securely submit medical documents electronically to support audit requests initiated by the esMD program, instead of manually printing, shipping and tracking.

Anthony Pryce, president and administrator of American Home Health Agency, based in Miami Lakes, Florida, said, “When we previously received an Additional Documentation Request (ADR) from CMS, we had to research, print and make copies of each document for that particular claim and then ship everything to the review contractor. Now, we just scan in our documents and upload everything via IVANS AuditDocs, saving us hundreds of dollars in shipping and labor charges, and freeing up our staff to focus on more pressing healthcare responsibilities. Additionally, we are able to track and confirm receipt of our ADR in real-time, which helps to ensure we are in compliance and speeds up the substantiation process.”

The CMS Office of Financial Management estimates that each year the Medicare fee-for-service program issues more than $35.4 billion dollars in improper payments and review contractors issue more than two million ADRs. When responding to an ADR, most medical documents are sent either in paper form or via fax. Under esMD, providers can work with a health information handler (HIH), such as IVANS, which has developed a CONNECT-compatible gateway that conforms to Nationwide Health Information Network (NHIN) standards and enables providers to submit medical documents electronically via the Company’s AuditDocs solution.

Vicky MacKay, patients accounts manager of Cottage Hospital in Woodsville, NH, is also enjoying the benefits of using AuditDocs. MacKay said, “Being audited can be a stressful and expensive process, and more hospitals are being asked by CMS to substantiate claims to help reduce improper payments. Since there are potentially hundreds of pages involved for each ADR, we wanted a solution that was secure, seamless and HIPAA compliant. IVANS AuditDocs makes it easy to quickly respond to an ADR from our desktop and we have peace of mind that the submission process is adhering to all CMS guidelines. Plus, we are able to conduct other healthcare transactions via IVANS LIME HIE platform in addition to AuditDocs, giving us a one-stop shop for the secure exchange of health information.”

The CMS esMD Gateway went live on September 15, 2011 with Phase 1. During this phase, Recovery Audit Contractors (RACs) will continue to send medical documentation requests via paper mail and providers will have the option to electronically send medical documentation to the RAC that requested it. During Phase 2, which is scheduled to go live by Fall 2012, the RACs will electronically send documentation requests to providers when their claims are selected for review.

Michael Schramm, president of IVANS healthcare services, said, “We understood that a more efficient way to deliver records during a payment audit was needed, and have been working closely with CMS on educating thousands of providers about the benefits of submitting medical documents electronically via the esMD gateway. Since its launch in September, IVANS has successfully submitted more than 6,000 pages electronically via AuditDocs, more than any other HIH participating in the CMS esMD initiative. We are proud to be leading this charge and expect this trend to continue as more providers look to IVANS to help them streamline the audit process and reduce administrative costs.”

Headquartered in Stamford, Conn. and a CMS approved vendor, IVANS, Inc. has more than 28 years of providing the property-casualty insurance and healthcare industries with fully managed network, electronic data interchange (EDI) and agency-company interface solutions to help solve complex business issues. IVANS LIME™ Health Information Exchange (HIE) Platform enables healthcare providers to connect with more than 4,300 Commercial, Medicare and Medicaid payers to manage their entire claims workflow and patient eligibility verification. Used every day by over half a million customers nationwide, IVANS LIME HIE works with all segments of the provider population to protect revenue and increase productivity by offering a one-stop solution for revenue cycle management, compliance and clinical applications. IVANS, Inc., which was formed by 21 insurance companies, also has offices in Tampa, Fla. and Cincinnati, Ohio.

For information, visit http://www.ivans.com/auditdocs. Visit IVANS healthcare blog, HealthWire, at http://www.ivans.com/healthblog.


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Cecile M. Locurto
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