Medical Record Electronic Submission
We are the Beneficiary and Family Centered Care Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!
Overview
Starting October 1, 2020, the Centers for Medicare & Medicaid Services (CMS) regulations require providers (including short- and long-term acute care hospitals, inpatient rehabilitation facilities, skilled nursing facilities, home health agencies, physicians, and all other unnamed providers) to send medical records to Acentra Health electronically via a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) approved method. Acentra Health will pay providers $3.00 for a complete patient record sent in an electronic format. For details, see the CMS FY2021 Inpatient Prospective Payment System (IPPS) Final Rule (PDF) pp. 1693-1722.
How To Submit Medical Records Electronically
Acentra Health’s medical record request will provide details on how to securely submit the patient records electronically. This new requirement will affect all review types performed by the BFCC-QIO, including quality of care complaints and appeals.
Watch a video: Medical Record Submission Process
Quality of Care Complaints
Providers will upload medical records to the managed file transfer (MFT) solution offered by CMS. Acentra Health will email the medical record request to the last email address that is on file. The medical record request will provide directions for providers to electronically upload the medical record into the MFT portal. If dates of services are incorrect, please send a list of all dates of service for the past three years. For more information, please review our provider instruction document (PDF).
Medical Record SubmissionAppealsChoose the correct button below based on your Case ID format. Use this button if the Case ID looks like this: 20240516_317_JB: Medical Record Upload - Appeals Use this button if the Case ID is a 9-digit number: Medical Record Upload - Appeals Higher-Weighted DRG (HWDRG) ReviewsClick on this button to upload records for HWDRG: Further AssistanceCall the toll-free number for your region and speak to a representative |
HIPAA PRIVACY RULE FINAL RULEThe U.S. Department of Health & Human Services (HHS) has issued a Final Rule to modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule to support reproductive health care privacy. Covered entities must now obtain a signed attestation before sharing health information related to reproductive care, ensuring it is not used for prohibited purposes. CMS has clarified that Medicare Beneficiary and Family Centered-Care Quality Improvement Organizations (BFCC-QIOs) are exempt from this requirement. Fraud AlertNational Government Services issued this fraud scheme alert. CMS has received numerous reports of illegitimate faxes being sent to healthcare providers and suppliers. CMS does not initiate audits via fax requests for medical records. If you think you received a fraudulent or questionable request, work with your Medical Review Contractor to confirm if it is legitimate. |
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Frequently Asked Questions
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Questions about
Submission (Applies to Submission of Appeals Records Only)
esMD remains an acceptable method of file transfer, but currently, esMD is not configured to fully accept medical records for either quality of care or appeal reviews. Acentra Health has worked with the esMD Application Developer on the proper configuration. We will provide updates as they occur.
The Final Rule instructs all providers and practitioners to submit records to the BFCC-QIO electronically.
This question is best answered by the Centers for Medicare & Medicaid Services (CMS). That said, Acentra Health will not turn off our fax server and therefore, does not intend for there to be delays. Providers can continue to submit via fax while working on their internal process changes in order to meet CMS’ requirement for electronic submission.
Providers will have two options for the submission of electronic medical records. One submission will be for the quality of care reviews required by CMS; the other for the appeals.
For quality of care reviews, providers will receive a telephone call asking providers for an email address to which we will send a secure medical record request. On the medical record request, providers will have a site where they can access and upload the requested medical record. Once received. those medical records will be electronically connected to the quality of care review in CMS' designated case review system - known as QMARS. To the best of our knowledge, this process can allow for multiple submissions, not multiple files (one upload per submission).
For appeals, CMS has allowed BFCC-QIO contractors to continue to work within their proprietary case review systems. In order to submit records or data securely, the provider will use our portal. When a provider uses our portal for submission of records, the data submitted is secure in transit. This is accomplished by using encryption protocol. Our system/portal allows for one file attachment per submission. However, multiple submissions are accepted for a single case. We will continue to work on enhancing our portal and hope to be able to allow for multiple file attachments in a single submission in the near future.
It is our understanding that files must be less than 200 MB in size for both systems.
For quality of care submission of records, the provider will be given a QMARS-generated medical record number that will need to be used when uploading the requested medical record.
For appeals, the provider will need to use the appeal number (format: yyyymmdd_123_AB) upon opening the portal. This appeal number will be validated with Acentra Health’s internal system to ensure there is an open/active case. Once the validation is complete, the right side of the portal will open, and the provider can upload the requested medical record.
Acentra Health’s portal is now available to the provider community as of October 1, 2020. We would recommend providers work with their Information Technology departments regarding the best practice for uploading the requested medical records. Different providers have different requirements regarding the saving of PHI on their computer systems. It would be best to follow the provider specific requirements.
At the current time, SNF providers are faxing this level of detail to the BFCC-QIO for a specific appeal. It may require SNF providers to scan these various components of the requested medical record and upload the file into the portal. Until such time as the SNF providers can accomplish this, fax transmission is still an option.
For the quality of care submission of records, the provider will be given a QMARS-generated medical record number that will need to be used when uploading the requested medical record.
For appeals, the provider will need to use the appeal number (format: yyyymmdd_123_AB) upon opening the portal. This appeal number will be validated with Acentra Health’s internal system to ensure there is an open/active case. Once the validation is complete, the right side of the portal will open, and the provider can upload the requested medical record.
Hospital discharge appeals, by their very nature, have a short turnaround time frame for the request and receipt of medical information. The Weichardt settlement and CMS instructions state the hospital has to provide the medical information to the BFCC-QIO by 12 pm (local time) on the day following notification of an appeal request. Due to this requirement, many, if not most, hospitals have designated weekday and weekend/off hours contact information which has been shared with the BFCC-QIOs. CMS is allowing both BFCC-QIO contractors to continue to use their proprietary appeal systems. Acentra Health will continue to notify the hospital-designated individuals with appeal requests by telephone and fax. Our outbound medical record request will include the web portal where the hospital can upload their medical records. Acentra Health will keep open its fax lines for a period of time, so that providers can continue faxing them while working on their internal systems.
Acentra Health protects data using TLS 1.2 and 1.3.
It is not necessary to scan on a high resolution for the medical records. The higher the resolution of the file, the larger it is, which will be more difficult to send. The default setting on scanners tends to be a high resolution. Please adjust the resolution settings, rescan the medical records, and try uploading them again. If possible, pdf files are recommended.
There are distinct time frames for the various mandatory reviews such as quality of care, appeals, and EMTALA. The CMS reference is for the quality of care (QOC) reviews. Providers do have 14 calendar days to submit those records. That is not the time frame for appeals. The due date/time noted on the appeal fax document is correct.
Medicare Advantage plans would be considered a provider when they are paying for care or services for a beneficiary. In the 2021 IPPS rule, a "provider" is defined as a healthcare facility, institution, or organization involved in the delivery of healthcare services for which payment may be made in whole or in part under Title XVIII of the Act. Acentra Health understands that providers may not be ready for this change; for that reason, Acentra Health will not be turning off its fax server and will process medical records received via fax.
This could constitute “Information Blocking” under the 21st Century Cures Act. Please refer to the Office of the National Coordinator for Health Information Technology’s (ONC) website defining information blocking practices, and exceptions to information blocking: https://www.healthit.gov/topic/information-blocking
If you believe that the problems you are experiencing with your EHR is the result of information blocking practices, please use ONC’s online form to report your experiences.
Reimbursement
At the current time, Acentra Health will be sending providers reimbursement checks. That format may change in the future, and if it does, we will provide updated information.
Payment will be made using the hospital’s contact information that is listed on the Memorandum of Agreement.
There is not a need for the hospital to send us an invoice for reimbursement. Our systems have collected the necessary information and will make appropriate reimbursement on a monthly basis.