HIMSS: Meaningful Use Stage 2 appeals process expanded--but not by much

The proposed rule outlining Stage 2 of the Meaningful Use incentive program expands the appeals process for eligible hospitals and providers--but not as much as they may have hoped, according to Pat Wise, vice president of health information systems for the Healthcare Information Management and Systems Society.

The HITECH Act prohibits an administrative or judicial review of the standards and methods used to determine eligibility and payment. In the proposed rule, the Centers for Medicare & Medicaid Services has suggested that providers be provided with an appeals process that would allow challenges of regulatory standards and methods--that is, those that CMS has created, as opposed to those created by the statute, which cannot be appealed.

"CMS has done its best [to create an appeals process]," she said yesterday, during a webinar on the impact of the Meaningful Use.The Stage 1 final rule established an appeals process only for the Medicaid EHR program. The Stage 2 proposed rule expands the appeals process to all eligible hospitals and professionals.

Three types of appeals have been proposed. "Eligibility" appeals allow providers that did not receive payments to offer evidence they met the program criteria and should have received a payment through no fault of their own. "Meaningful Use" appeals allow providers to show they met the standards using certified electronic health records technology and successfully attested. "Incentive payment" appeals challenge the claims count used for attestation.  

The proposed rule also specifies the deadlines for submitting appeals and other requirements, such as the need to supply requested supporting documents within seven days, Wise noted.

CMS had announced some of this information last month on its appeals website, clarifying, among other things, that appeals support will be provided by CMS' Office of Clinical Standards and Quality and that Provider Resources, Inc. of Eire, Pa. has been selected to hear appeals.

To learn more:
 - here's the proposed Stage 2 Meaningful Use rule
 - get info on HIMSS' educational events
 - see more about the appeals process on CMS' website