EHR incentive appeals process in the works for CMS

In its ongoing efforts to implement the Medicare electronic health record incentive program, the Centers for Medicare & Medicaid Services has awarded Erie, Pa.-based Provider Resources, Inc. a $2.25 million contract to help the agency establish and maintain an appeals process for providers who wish to challenge CMS decisions regarding eligibility, payment amounts, attainment of meaningful use, and other issues.

According to the government's notice of the contract award, Provider Resources will assist CMS in the development, implementation, evaluation, and promotion of a system/infrastructure to support the Medicare EHR incentive administrative appeals process. The contractor also will assist in troubleshooting, and collaborate with internal and external partners and stakeholders to perform outreach regarding the appeals process.

CMS had indicated in the final rule implementing the incentive program that guidance regarding appeals was forthcoming. The final rule was published in the Federal Register in July 2010.

Provider Resources' contract does not extend to appeals under the Medicaid EHR incentive program. The final rule requires that states establish their own appeals program for providers as part of a demonstration to the Department of Health & Human Services that they are conducting adequate oversight of the EHR incentive program. However, it allows flexibility for states in establishing their appeals programs. States can set their own reasonable criteria for appeals, limit the issues on appeal and adopt other procedures.

CMS noted in the final rule that it is working with states to integrate its appeals process for providers that participate in either program.

To learn more:
- read this article from Government Health IT
- check out the final rule (.pdf)
- here's' notice of the contract award

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