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How to File an Appeal We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome! |
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hospital discharge appeals
If you have Medicare (including Medicare Advantage), you have the right to appeal a hospital discharge if you feel too sick to leave. The hospital will give you a form called "An Important Message from Medicare." This form tells you how to appeal the discharge.
If you call Kepro for an appeal, Kepro’s doctor will look at the medical record to see if you should stay in the hospital.
During the appeal,
- You do not have to leave the hospital.
- You do not have to pay for the extra days in the hospital while Kepro reviews the medical record.
skilled service termination appeals
If you have Medicare (including Medicare Advantage), you have the right to appeal a discharge if you do not agree with the decision that skilled services will be stopped. You must be given a letter called a Notice of Medicare Non-coverage with the planned discharge date explaining how to appeal.
Once you receive the letter, you can call Kepro. Kepro’s doctor will look at the medical record to see if the services should continue.
beneficiary care management program (bcmp)
The Beneficiary Care Management Program (BCMP) is a Centers for Medicare & Medicaid Services (CMS) Person and Family Engagement initiative supporting Medicare Fee-for-Service beneficiaries undergoing a discharge appeal, who are experiencing chronic medical conditions requiring lifelong care management. It serves as an enhancement to the existing beneficiary appeals process. This program is not only a resource for Medicare beneficiaries, but extends support for their family members, caregivers and providers as active participants in the provision of health care delivery. So what services are offered by this program? The BCMP program will focus on these key care management support services:
- Discharge Planning and Care Coordination
- Healthcare Care Navigation
- Beneficiary Empowerment and Self Care
Please make note that the BCMP program is a referral-base program, initiated by your BFCC-QIO. If you or a family member have an active discharge appeal, we encourage you to contact the regional BFCC-QIO to discuss if you could benefit from this service. At your convenience, you may also access additional program information at: www.bcmpqio.org.
denial of coverage from a medicare advantage plan
If you have a Medicare Advantage plan, you have some additional Medicare rights. If you are concerned that you cannot get the care you need, you have the right to appeal to the Medicare Advantage plan. You can appeal things like denials for:
- Referrals to a specialist;
- Approval for tests (like x-rays or blood tests); and
- Payment of a bill.
The Medicare Advantage plan has information about how to start the appeal process. If you feel you may get worse by waiting too long, you can ask for an expedited appeal. This means the Medicare Advantage plan must make a decision about the appeal within three calendar days. If you need this faster review, ask your Medicare Advantage plan for an “expedited appeal.”
For additional information about a denial of coverage, call 1-800-MEDICARE.
kepro contact information
| Telephone, Fax Numbers and Mailing Addresses | ||||
| Region 1 Connecticut Massachusetts Maine New Hampshire Rhode Island Vermont |
Region 4 Alabama Florida Georgia Kentucky Mississippi North Carolina South Carolina Tennessee |
Region 6 Arkansas Louisiana New Mexico Oklahoma Texas |
Region 8 Colorado Montana North Dakota South Dakota Utah Wyoming |
Region 10 Alaska Idaho Oregon Washington |
| Toll-free Phone 888-319-8452 Local Phone 216-447-9604 TTY 711 Toll-free Fax Mailing Address 5700 Lombardo Center Dr. Suite 100 Seven Hills, OH 44131 |
Toll-free Phone 888-317-0751 Local Phone 813-280-8256 TTY 711 Toll-free Fax Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-315-0636 Local Phone 216-447-9604 TTY 711 Toll-free Fax Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-317-0891 Local Phone 813-280-8256 TTY 711 Toll-free Fax Mailing Address 5700 Lombardo Center Dr. Suite 100 Seven Hills, OH 44131 |
Toll-free Phone 888-305-6759 Local Phone 813-280-8256 TTY 711 Toll-free Fax Mailing Address 5700 Lombardo Center Dr. Suite 100 Seven Hills, OH 44131 |
For additional information about asking for medical records, please complete a Medical Record Request Form.
