The Centers for Medicare & Medicaid Services (CMS) is starting an informal appeals process this month for the 2011 PQRS and e-prescribing programs. Physicians may request an informal appeal via the QualityNet Help Desk, and CMS will review the data to determine whether CMS made a mistake in calculating the penalty for not e-prescribing.
Contact the QualityNet Help Desk by telephone at (866) 288-8912 or by email Monday through Friday from 7 am to 7 pm.
Potential informal appeal topics include:
- You are not included on the list of eligible professionals able to participate in the program.
- You did not understand the percentage amount used to calculate your incentive (i.e., 2 percent, 1 percent, etc. of covered Medicare Part B services to fee-for-service patients).
- Your group National Provider Identifier (NPI) number was used on claims instead of your individual NPI.
Physicians needing help with e-prescribing or the Medicaid or Medicare electronic health record (EHR) incentive programs can turn to the Texas regional extension centers (RECs). Currently, all four RECs provide low-cost consulting to primary care physicians, thanks to federal grants to offset the cost. Visit the Texas REC Resource Center on the TMA website.
For questions on the federal EHR program or other office technologies, contact TMA's Health Information Technology Department by telephone at (800) 880-5720 or by email.
Action, Jan. 3, 2012