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. 

Kepro Telephone Numbers

march is national nutrition month®

National Nutrition Month® is a time when people can focus on eating healthier.

You can use this information - including many different websites - to learn more about ways to improve your health and nutrition.

Read more: www.keproqio.com/nutritionmonth

news about medicare part d

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan.

In August 2022, President Biden signed the Inflation Reduction Act of 2022 into law. The new law made improvements to Medicare by expanding benefits and lowering drug costs.

For the first time, beginning in 2025, the drug law requires all Medicare prescription drug plans — including both stand-alone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer the option to spread out-of-pocket drug costs throughout the year instead of paying all at once at the pharmacy. This is especially helpful for those with Medicare Part D who have high cost-sharing earlier in the year.

During Medicare Open Enrollment this year, Medicare Part D enrollees will be able to choose the Medicare Prescription Payment Plan for the 2025 plan year. Part D enrollees will also have the opportunity to opt in throughout the year.

Read more:

Medicare Prescription Payment Plan Implementation (PDF)

Part D Basics

listen to the latest podcast episode: heart disease

In this episode you will learn about heart disease and the symptoms of different types.

Episode 21: American Heart Month Podcast - Learn About Heart Disease

Same services, but with a new name and look! Kepro will soon be known as Acentra Health. Stay tuned for exciting new updates!

in this issue:

when are you able to use kepro's free immediate advocate services?

a free service for anyone who has medicare

Kepro has a free service called Immediate Advocacy that is available to anyone who has Medicare, including Medicare Advantage. It could be a useful service to you either now or in the future. We never really know what the future holds!

Immediate Advocacy services can help quickly resolve issues related to your medical care. This process doesn’t involve a review of your medical record. Therefore, the results are faster.  

For example, you may need answers to your medical questions. However, what happens if the doctor’s office does not call you back? There can be times when you try to call the doctor, but you keep getting a busy signal. What happens when you can’t leave a message?

It is a good thing that for issues like these, Kepro can promptly resolve them with Immediate Advocacy.  

Regrettably, communication issues are quite common. Read this example about a patient’s family who called Kepro asking about Immediate Advocacy services. They needed some help understanding the patient’s plan of care.

READ THE STORY

Eugenio had a visit with his nephrologist. A nephrologist is a medical doctor who specializes in diagnosing and treating kidney conditions. During this visit, the doctor was concerned about a few things with Eugenio’s health. To be safe, the doctor admitted him to the hospital for further care and testing.

After his tests showed good results and Eugenio started to feel better, the doctor was ready to discharge him. Eugenio was happy because he was ready to be in the comfort of his own home. However, before leaving, hospital discharge planning needed to take place. Hospital discharge planning is a step that helps determine what you need at home to continue your recovery.

Hospital staff – in this case, a discharge planner – stopped by to explain the process and talk about things he may need at home. The meeting also included a review of his care plan. This was done to make sure he clearly knew what to do to continue healing at home. After the meeting, everything was double-checked, and Eugenio left the hospital.

It was such a relief to be back home. After all, there’s nothing like your own bed and a great night’s sleep. While resting after his medical ordeal, Eugenio thought it would be a good idea to refresh his memory about his discharge plan. This was a wise step, as discharge plans can help prevent the need to go back to the hospital for the same issue. The goal is to make your move from the hospital to your home or another facility as safe as possible. Discharge plans should note where you will be sent, the types of care you will need, and who will provide that care. Also, there should be a complete list of your medicines with dosages and their uses.

Unfortunately, as he looked through the plan, Eugenio became a little confused. He was alone when he met with the discharge planner, but he usually had family in his hospital room visiting during the day. His family would help him with the language barrier, as English was Eugenio’s second language. He mainly spoke Spanish at home.

Now that he had questions, he wasn’t sure how to get this cleared up. Thankfully, while his sister, Lucia, was looking through the paperwork from the hospital, she found a phone number for Kepro. After asking her brother if it was okay to call, Lucia reached out to Kepro.

Right away, she was transferred to a Kepro nurse in the Immediate Advocacy department. Lucia explained what happened and her brother’s concerns. The Kepro nurse carefully listened and asked a few questions to be sure she understood everything.

Then, the Kepro nurse called the hospital and was able to speak to the discharge planner. After explaining the situation, Kepro was able to arrange a 3-way call. Included on the call were Kepro, Eugenio and his sister, and the nurse from the hospital. By making sure Eugenio’s family member was involved, the language gap was closed. It really helped Eugenio understand what he needed to do.

When you call Kepro and need to speak to someone using a language other than English, please let Kepro staff know. Kepro has translation services that enable you to get assistance while speaking other languages.

If you have Medicare and are not happy with the care you received, or if you need help working through an issue that needs to be taken care of right away, please call Kepro and ask about our free Immediate Advocacy services.

Read more:

Kepro’s website: Immediate Advocacy services

To ensure that your discharge is successful, keep the following in mind:

• Hospital Discharge Planning
• Hospital Discharge Planning: A Guide for Families and Caregivers

you have rights in an emergency department. it's the law.

At some point in time, you may find that you need to go to a hospital’s emergency department for care. While never ideal, if that day comes, we want you to know about your rights to emergency medical care under the Emergency Medical Treatment and Labor Act. This is also referred to as EMTALA.

The EMTALA law helps prevent hospital emergency departments from refusing to treat patients. The law applies to hospitals that receive Medicare funds, which includes most hospitals in the United States.

Your protections under EMTALA mean that a hospital emergency department must:

1. Give you an appropriate medical screen exam. A qualified professional must check you for an emergency medical condition. The hospital must offer you this screening exam, even if you don’t have insurance.
2. If you have an emergency medical condition, the hospital must offer to treat this condition so that it does not get worse.
3. If the hospital doesn't have the ability to stabilize your emergency medical condition, it must offer to transfer you to a hospital that is able to treat your issue.

The Medicare website can help you understand your rights under EMTALA and how to file a complaint if you were denied emergency medical care.

Read more about EMTALA: Emergency Room Rights

Publication No. RI146810-342-3/2024. 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.