In January 2012, CMS made available a two-tiered administrative process that allows practitioners and hospitals to appeal decisions pertaining to the EHR Incentive Program in limited circumstances. Specifically, CMS allows three types of appeals of individual determinations regarding:
- Eligibility: All program requirements were met and that he/she should have received a payment but could not because of circumstances outside of the practitioner’s control
- Meaningful use: Practitioner used certified EHR and is a meaningful user
- Incentive payment: Practitioner provided claims data for inclusion that was not used in determining the amount of the incentive payment and the incentive payment calculation is correct after a subsequent federal determination otherwise
This process does not allow for appeals regarding the regulations promulgated by CMS, given the explicit statutory prohibition against such appeals, but rather for appeals regarding the application of the rules in these three areas to particular individuals or entities.
For further information on appeals, visit the CMS website.