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Case Review Connections 

Acute Care Edition

Issue 18: Summer 2019 

If you want like to communicate BFCC-QIO information, please contact KEPRO at KEPRO.Communications@kepro.hcqis.org and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.

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In this issue:

Medical Director's Corner Tips for Success with the Appeals Process
Memorandum of Agreement Success Stories with Immediate Advocacy
Case Status Check Tool Frequently Asked Questions
Physician Acknowledgement Process Educational Presentations

medical director's corner - ferdinand richards III, md

I want to thank our providers for their assistance during the recent transition period. One of the primary roles of the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is medical record review. I would like to share with you some information about our Peer Reviewers, who are responsible for the determinations for these reviews. Our Peer Reviewers are spread across the country. It is our goal to make sure that our reviews are completed properly and in accordance with evidence based on medical practice and utilization guidelines from the Centers for Medicare & Medicaid Services (CMS). To achieve that, we focus on education for our Peer Reviewers which consists of three primary modes: web portal, conference calls, and one-on-one feedback.

Our staff of medical directors oversees the peer review process. The oversight process includes inter-rater reliability (IRR), monthly review audits, and tracking and trending. We value your feedback in this process and look to that input as a barometer of our performance. If you have any questions or feedback, please feel free to contact me at frichards@kepro.com or 813-280-8256, extension 7203.

memorandum of agreement

All providers are required to complete a new Memorandum of Agreement (MOA), even if one was submitted to KEPRO prior to June 8, 2019. Providers should complete the MOA online, and once it is submitted, providers can expect to receive a fully executed copy of the MOA from KEPRO within 30 days of submission. 

case status check tool

KEPRO is glad to announce that the online Case Status Check tool is once again available. Medicare providers and patients can check the case status online for appeals cases started on or after July 14, 2019.

tips for success with the appeals process

Make sure that:

  • The Important Message from Medicare is issued both at admission and two days prior to discharge. Remember that it is not issued if the patient has observation status.
  • KEPRO's information and phone number have been updated on your facility's copy of the Important Message from Medicare.
  • Weekend staff is familiar with the BFCC-QIO appeals process.
  • The BFCC-QIO has the correct contact information for your facility, both for weekdays and weekends/holidays. You can update your facility’s information online.
  • Please return the medical record request with the bar code along with the medical record.

physician acknowledgement process

As the BFCC-QIO, we are required by CMS to monitor prospective payment system (PPS) hospital compliance with securing physician acknowledgment statements for newly appointed physicians. We conduct this monitoring on an annual basis. More information, including the submission template, is available on the physician acknowledgement page on our website.

success stories with immediate advocacy

Immediate Advocacy is an informal process in which the BFCC-QIO acts as a liaison for the Medicare beneficiary to quickly resolve an oral complaint. KEPRO would like to share success stories with providers to show how Immediate Advocacy can benefit providers by resolving problems quickly, which leads to improved patient relations.

A beneficiary contacted the BFCC-QIO with concerns about his medical records. He had requested them from the hospital, but they had not sent them. He requested assistance from KEPRO.

The Clinical Care Coordinator (CCC) asked him if he had signed a Release of Information form, and he said that he had not. The CCC then asked the beneficiary for permission to make a three-way call with the hospital. The CCC was able to call the hospital medical records department. The beneficiary told the representative what he needed, and she told the beneficiary how to complete the form and what to do with it once it is complete. The beneficiary then expressed his appreciation to the CCC for helping him understand the process.

frequently asked questions

Q. Does KEPRO provide translation services?
A. Yes, these services are available for people who call in as well as send in written correspondence.
Q. The social workers at my facility would like to know if state resources are available for Medicare beneficiaries?
A. Yes. When you click on an individual state on the map on our homepage, you will be directed to resources for that particular state.

educational presentations

KEPRO has Outreach Specialists available to provide presentations to providers and stakeholders in our regions. These presentations are primarily done virtually by webinar. Contact the outreach specialist for your region for more information.

Publication No. R146810-42-09/2019. 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. 

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