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EHR Incentive Program Administrative Appeals EHR Incentive Program Administrative Appeals Support The Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs Final Rule, CFR 42 Parts 412, 413, 422 et al., (Final Rule) provides guidance and requirements for a Medicaid appeals process, but does not provide an appeals process for the Medicare EHR Incentive Program. CMS is currently implementing an appeals process for the EHR Incentive Program. CMS is pleased to announce that the contract for the administrative review of certain EHR Incentive Program determinations has been awarded to Provider Resources, Inc. (PRI) located in Erie, Pennsylvania. As the appeals support contractor, PRI will be working with the Office of Clinical Standards and Quality (OCSQ), an office within CMS, to provide customer service support and technical assistance to all users of the system and the tools implemented to support the EHR Incentive Program Administrative Appeals. Effective November 1, 2011, PRI began collecting input regarding the appeals process. Since that time, OCSQ has developed further guidance regarding the EHR Incentive Program appeals process. As of December 1, 2011, PRI began accepting appeals for eligible professionals and eligible hospitals. Interested parties may reach the appeals support contractor or the OCSQ Appeals Support Center either by email at OCSQAppeals@provider-resources.com or the toll free number at 1-855-796-1515. The OCSQ Appeals Support Center is available between the hours of 9 a.m. and 5 p.m. EST Monday through Friday. For the record: Final Rule: In addressing comments on the creation of an appeal process for the EHR Incentive Program CMS stated in the Final rule for Stage 1 that a Medicare appeals process would be addressed through future guidance. The relevant sections of the final rule addressing an appeals process for the Medicare EHR Incentive are available in the downloads section below in the document titled Final Rule Appeals Ref [PDF 36 KB]. Eligible Hospitals: Originally, eligible hospitals or representatives filing an eligibility appeal on behalf of eligible hospitals could file an appeal no later than December 30, 2011 for the 2011 EHR Incentive Program reporting period. However, CMS has extended the filing deadline to January 30, 2012. Eligible hospitals' appeals can be requested via email or telephone utilizing the customer service support center provided by PRI. Guidance: Guidance for the Administrative Review of Certain Electronic Health Record Incentive Program Determinations is available in the downloads section below. This guidance provides a step-by-step explanation on how a provider files an appeal in the Medicare EHR Incentive Program. Beginning in February 2012, appeal opinions will be posted on the OCSQ website.
Page Last Modified: 01/12/2012 8:04:26 AM
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