On the Healthcare Front
Issue #13: March 2023
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when should you call kepro?
- If you are not ready to be discharged from the hospital.
- If your Medicare skilled services are ending too soon. Examples of skilled services include things like physical therapy and nursing services.
- If you have a concern about the quality of care you received.
- If you have a concern about your medical care that needs to be taken care of right away.
Click on the link below for the phone number for your state. These services are free for people who have Medicare.
march is national nutrition month
National Nutrition Month is a time to focus on eating healthier. These resources can be used by everyone to learn more about ways to improve health and nutrition.
Visit our nutrition month page and look under the section called for Everyone for information for older adults:
Read more about nutrition: www.keproqio.com/nutritionmonth
saving money with the prescription drug law
A new prescription drug law that went into effect January 1, 2023, will help save money for people with Medicare.
This law improves access to affordable treatments and strengthens the Medicare program. Here’s what the law means for you:
Medicare has information to help people with Medicare understand the reduced drug costs made possible under the Inflation Reduction Act:
One of Kepro’s free services is to help Medicare patients file hospital discharge appeals. But what does that really mean? Let’s take a look at this process.
If a Medicare patient is being sent home (discharged) from the hospital and the patient doesn't feel ready to leave, they can call Kepro and ask to appeal (or stop) the discharge.
In order to appeal (or stop) your discharge, you have to be an inpatient. There is no official way to appeal your discharge if you are in observation or outpatient status. If you’re ever admitted to a hospital, be sure to ask your doctor or nurse what status you are in.
Always try to read paperwork that hospital staff give you. When you’re admitted to the hospital and again before discharge, you will get paperwork called "An Important Message from Medicare." This document will tell you about your hospital discharge appeal rights, including the phone number for Kepro and what you need to do to appeal the discharge.
After you have filed an appeal to stop your discharge, what comes next?
- Will Medicare continue to pay for your hospital stay while your appeal is happening?
- Can the hospital discharge you during the appeal process?
- How will you hear about the appeal decision?
Let’s get answers to these questions.
After an appeal is started, Kepro will contact the hospital and ask for a copy of your medical record. An independent physician reviewer will look at your medical record to see if you should stay in the hospital. The physician reviewer considers what is included in your medical record when deciding if you should continue to stay in the hospital or be discharged. The physician reviewer also considers the statements made by you (the Medicare patient) or whoever calls Kepro to file the appeal on your behalf.
While you are in the hospital and Kepro is reviewing your appeal, you do not have to leave the hospital. And, if you have requested an appeal before the deadline, Medicare will continue to pay for your care during the appeals review process. You will find information about deadline dates to file an appeal in the paperwork you received from hospital staff - “An Important Message from Medicare."
Hospitals must give you the Important Message for Medicare after you are admitted and again before you are discharged. If you didn’t get it, please ask for it.
Within one calendar day after Kepro gets all the information needed (your medical record and all associated documents), you will get a phone call from Kepro to let you know if you can stay in the hospital or if you will be discharged. If your appeal was approved and you stay in the hospital, Medicare will continue to pay for your stay in the hospital. You will also get a letter in the mail with information about the appeal.
If Kepro does not approve the appeal and you still don’t feel ready to leave the hospital, there is something you can do.
When you get the phone call, the nurse will give you information about something called a reconsideration review. This is when a different independent physician reviewer looks at your medical record and the appeal. During the reconsideration, you could have some financial responsibility.
The physician reviewer considers what is included in your medical record when deciding if you should continue to stay in the hospital or be discharged. You can help important information get into your medical record by being engaged with your health care.
Listen to Kepro's podcast episode – How the Appeals Medical Record Review Process Works – where Kepro’s Medical Director talks about how to be more engaged with your care.
Listen to Kepro’s appeals video on YouTube: Do you have Medicare? Learn how to file an appeal.
Read more on Kepro's website: Information about Kepro services for people who have Medicare
More information about the Important Message from Medicare document: www.hhs.gov
If you want to file an appeal or if you have any questions about Kepro, please call us. Our phone numbers are on our website: www.keproqio.com/contactus
There are many titles that you can get in different formats, including large print, from Medicare.gov, which is the official website for Medicare.
As someone with Medicare, you should have received the 2023 edition of Medicare & You. It gives a summary of Medicare benefits, coverage decisions, rights and protections, and answers frequently asked questions about Medicare. If you haven’t received it, you can order it on Medicare’s website: www.medicare.gov/publications. You can also download a PDF version to save on your computer.
Other popular Medicare publications include:
- Your Guide to Choosing a Nursing Home
- Guide to Choosing a Hospital
- Medicare and Home Health Care
- Your Medicare Benefits
- Medicare Coverage of Durable Medical Equipment and Other Devices
- Your Discharge Planning Checklist
- Staying Healthy
Would you like to read Medicare publications on your tablet?
There are titles available as e-books that you can download and read on your tablet: www.medicare.gov/pub/ebooks.
Publication No. R146810-291-2/2023. This material was prepared by Kepro, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.