EHR Incentive Program Appeals Process

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Posted By: Roberta Mullin March 13, 2012

EHR Eligibility, Meaningful Use and Incentive Appeals

The Final Rule we now live under for Stage 1 Meaningful Use provides the guidance and requirements for appeals in the Medicaid EHR Incentive Program but does not for the Medicare Program. It states that an appeals process for Medicare would be addressed through future guidance. The CMS Office of Clinical Standards and Quality (OCSQ) is responsible for providing the appeals guidance on how to file appeals. EHR incentive appeals have been accepted and the first informal review decisions have been made. Provider Resources Inc. was contracted by CMS to supply customer support and technical assistance for incentive program appeals.

The EHR incentive program appeals process includes an informal review and a request for reconsideration. In each of these there are three types of appeals.

  1. In an Eligibility Appeal a provider has met all the program requirements and should have received an EHR incentive but could not because of a circumstance outside the provider’s control. The deadline for this appeal is 30 days after the 2 month period following the payment year. This means March 30, 2012 for EPs.
  2. In a Meaningful Use Appeal a provider has shown that he or she used certified EHR technology and met the meaningful use objectives and associated measures after a successful attestation. The deadline for this appeal is 30 days from the date of the demand letter or other finding that could result in the recoupment of an EHR incentive payment.
  3. In an Incentive Payment Appeals it is for Medicare EPs only and a provider has shown that he or she provided claims data not used in determining the incentive payment amount. The deadline for this appeal is 60 days from the date the incentive payment was issued or 60 days from any Federal determination that the incentive payment calculation was incorrect.

For general questions and for information on how to file an EHR incentive program appeal, eligible professionals (EPs), eligible hospitals, critical access hospitals, Medicare Advantage Organizations, and Medicaid eligible hospitals may contact OCSQ’s designated appeal support contractor by phone or email. Office hours are Monday through Friday 9am to 5pm ET.

  •  Toll-free number: 855-796-1515
  • Email: OCSQAppeals@provider-resources.com

You can also find general information on the Appeals page on the EHR Incentive Program web site.