CMS Sets Appeals Process for EHR Incentives

CMS has released a guidance document detailing the steps that health providers must use to appeal a decision relating to applying for incentives to adopt electronic health records (EHR) technology. Under the Health Information Technology for Economic and Clinical Health (HITECH) Act, eligible health professional and hospitals can qualify for payment incentives to adopt EHR. 

Incentive payments started being disbursed in 2011 and will be available to eligible providers under the Medicare program for four consecutive years until 2016. Eligible professionals may receive up to $44,000 if they meet the requirements to receive incentive payments during all five years of the program. If providers have not adopted EHR technology by 2015, they face reductions in their Medicare payments. 

According to the CMS guidance, EHR incentive appeals will be handled by CMS’ Office of Clinical Standards and Quality (OCSQ). The OCSQ will manage a two-level appeal process, which includes an informal review and a request for reconsideration. Within that two-level appeal process, three types of appeal will be available—

  1.  An eligibility appeal allows a provider to show that all the EHR incentive program requirements were met and that he or she should have received a payment but could not because of circumstances outside of the provider’s control.
  2.  A meaningful use appeal allows a provider to show that he or she is using certified electronic health record technology and met the meaningful use objectives and associated measures after a successful attestation. 
  3. An incentive payment calculation appeal allows a provider to show that he or she provided claims data for inclusion that was not used in determining the amount of the incentive payment. (This type of appeal is only available for individual providers, not institutional ones.) 

The guidance provides information on who providers contact to make an appeal, general filing requirements for an appeal filing, and issues precluded from review.