CMS lays out how to appeal meaningful use decisions

Physicians who believe they were given an incorrect bonus can file for reconsideration.

By — Posted Feb. 9, 2012

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The Center for Medicare & Medicaid Services' Office of Clinical Standards and Quality announced the establishment of a two-tier appeals process for physicians who were deemed ineligible for Medicare meaningful use incentive pay, or who thought their pay was too low.

There are three types of appeals physicians can file:

  • An eligibility appeal will allow doctors to show that all the requirements to earn an incentive payment were met, but payment was not received due to circumstances outside of his or her control. Eligibility appeals must be filed before March 30 to appeal decisions for payment year 2011.
  • A meaningful use appeal allows physicians to show that they used a certified electronic medical record system and met all meaningful use objectives and measures. These appeals must be filed within 30 days of the physician receiving a demand letter or other finding from the review board.
  • An incentive payment appeal allows physicians to show that they provided claims data for inclusion on the attestation documentation that was not used in determining the amount of the incentive payment. This appeal must be filed within 60 days of receiving the incentive payment, or within 60 days of receiving a letter stating the payment amount was incorrect.

The appeals process is two-tiered, with an informal review and a reconsideration. Informal review decisions will be made within 90 days of the request. Physicians have 15 days after the informal review decision to file a request for reconsideration.

CMS contracted with Provider Resources Inc. to facilitate the appeals. PRI also will offer guidance to doctors going through the appeals process. They can contact PRI by calling 855-796-1515 or sending an email ([email protected]" target="_blank">link). All appeals must be filed through a dedicated Web portal (link).

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