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New EHR Incentive Program Appeals Process

Beginning on March 1, 2012, CMS will open an Appeals Portal for Eligible Professionals participating in the EHR Incentive program. (The portal for Eligible Hospitals is slated to be up by June 1, 2012.) Until such time as the Appeals Portal is up, the guidance available is here. According to this document, the types of appeals that can be submitted are as follows:

OCSQ will afford providers with a two-level appeal process including an informal review and a request for reconsideration. Within the two-level appeal process, there are three types of appeals that can be filed in the EHR Incentive Program: (1) eligibility, (2) meaningful use, and (3) incentive payment.

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 used certified EHR technology and met the meaningful use objectives and associated measures after a successful attestation.

3. An incentive payment 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.

EPs and EHs considering an appeal should read the full guidance — especially related to the deadlines.

For technical issues contact the OCSQ Appeals Support Center either by email at OCSQAppeals@provider-resources.com or at the toll free number: 1-855-796-1515.

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