The Centers for Medicare & Medicaid Services (CMS) announced April 3 that the deadline for eligible professionals (EPs) to submit eligibility appeals under the Medicare EHR Incentive Program’s 2011 payment year has been extended to April 30, 2012. CMS said the new deadline gives EPs an extra month to file their appeals.
An eligibility appeal allows a provider to show that all requirements for the Medicare EHR Incentive Program were met, and that he or she “should have received a payment but could not because of circumstances outside of the provider’s control,” CMS stated in an electronic bulletin.
Providers may ask for an informal review or a request for reconsideration, according to CMS. Under the Medicare EHR Incentive Program, eligibility is one of three types of appeals that may be filed; the other appeal types pertain to meaningful use determinations and incentive payments.
Detailed guidance on the appeals process and additional information on appeal types can be accessed on the website of the Office of Clinical Standards and Quality (OCSQ). An appeals support contractor, Provider Resources Inc. (PRI), works with OCSQ to provide technical assistance to users of the system/tools supporting the EHR Incentive Program Administrative Appeals.
For general questions or information on how to file an appeal, providers may contact PRI toll-free at 855-796-1515 between 9:00 a.m. and 5:00 p.m. EST, Monday through Friday. You may also send your inquiry via e-mail at .