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Meaningful use appeals process guidance released

HIM Connection, January 31, 2012

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The CMS Office of Clinical Standards and Quality (OCSQ) introduced a new appeals process, last updated on January 12, for providers to file appeals regarding the Medicare EHR Incentive Program.

Within the two-level appeals process, provides may file one of three types of appeal:

• An eligibility appeal allows the provider to show it met all requirements and therefore should have received payment but could not because due to circumstances outside their control
• A meaningful use appeal allows the provider to show they are using approved EHR technology and have met the meaningful use objectives
• An incentive payment calculation appeal allows a provider to show claims data for inclusion that was not used in determining an incentive payment

Providers should note that they must raise all relevant issues during the initial appeal, according to the guidance. They may amend the appeal only in extenuating circumstances. Also, they must file all appeals by the appropriate deadlines:

• Eligibility Appeals: Appeals for eligibility must be filed no later than 30 days following the close of the attestation period. For example, eligible hospitals have until December 30, 2011 and eligible professionals have until March 30, 2012 to file an eligibility appeal for payment year 2011.
• Meaningful Use Appeals: Appeals for meaningful use, which typically challenge the results of a meaningful use adverse audit, must be filed no later than 30 days from the date of the demand letter or other finding requesting the recoupment of an incentive payment.
• Incentive Payment Calculation Appeals: Appeals for incentive payments must be filed no later than 60 days from the date the incentive payment was issued or 60 days from any finding that affects the incentive payment.

For more information, visit the EHR Incentive Program Appeals section of the CMS website.

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