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Case Review Connections 

Acute Care Edition

Issue 20: Spring 2020

If you want to communicate BFCC-QIO information, please contact KEPRO at QIOCommunications@kepro.com 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 An Immediate Advocacy Success Story
COVID-19 Guidance for Providers Frequently Asked Questions
Physician Acknowledgement Monitoring Staff Education about BFCC-QIO Services
Appeals - Update on the Important Message from Medicare  

medical director's corner

The Centers for Medicare & Medicaid Services (CMS) Quality Conference was held recently from February 25 – 27, 2020, in Baltimore, Maryland. The goal of the conference was to “convene leaders across the health care spectrum, to explore how patients, advocates, providers, researchers, and champions in health care quality improvement can develop and spread solutions to address America’s most pervasive health system challenges.” There were three plenary sessions that are available for viewing. The Twitter feed is also available at #CMSQualCon20. Some of the topics that were covered include:

  • Advancing Person-Centered Care/Patients over Paperwork
  • Addressing the Opioid Epidemic and Patient Safety
  • Targeted Focus of Rural Health and Underserved Populations
  • Fostering Innovation Remarks from Seema Verma, the CMS Administrator, are also available.

If you are interested in more information about the conference, please visit www.cmsqualityconference.com.

covid-19 guidance for providers

CMS is providing guidance to providers regarding COVID-19. Waivers are in place including information about the three-day hospital stay prior to admission to a skilled nursing facility. CMS also has a webpage dedicated to information about the virus, including all of their press releases. A Virtual Toolkit is available to help you stay up-to-date on CMS materials.

physician acknowledgement monitoring

One of the responsibilities of the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is to monitor physician acknowledgements from hospitals that are paid under the prospective payment system (PPS). Hospital staff are required to obtain a signed acknowledgement when a physician is granted admitting privileges or admits his or her first patient. If a hospital fails to comply, CMS may

  • Withhold Medicare payment, in full or in part, to the hospital until the hospital provides adequate assurances of compliance; or
  • Terminate the hospital's provider agreement.

Learn more about the physician acknowledgement process.

appeals – updates on the important message from medicare

Hospitals are required to deliver the Important Message from Medicare (IM), formerly CMS-R-193 and now CMS-10065, to all Medicare hospital inpatients to inform them of their hospital discharge appeal rights. A Detailed Notice of Discharge (DND) explains the specific reasons for a discharge and is given only if a patient requests an appeal.

CMS made changes to the IM and DND forms and is requiring providers to begin using the new forms by April 1, 2020. For detailed information, visit the Hospital Discharge Appeal Notices page of CMS’ website at www.cms.gov/bni.

Providers should direct all questions regarding these forms to CMS by completing and submitting the online form using the BNI option.

immediate advocacy success story

Immediate Advocacy is an informal process in which the BFCC-QIO acts as a liaison for people with Medicare 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 Medicare patient was concerned about her hospital discharge because two physicians gave her different information. She was told by her attending physician that she was not being discharged, but the covering physician came in later that day and told her that she was. The patient then asked the nurse, who also said she was being discharged. The staff provided no discharge instructions of any kind, no prescriptions, and no information about her follow-up appointments at discharge. The patient called KEPRO for assistance.

The Clinical Care Coordinator (CCC) from KEPRO contacted the hospital and spoke with the charge nurse. She stated that she would review the patient’s discharge information and go over everything with her. The CCC then called the patient to let her know that the charge nurse would be following up with her that day.

frequently asked questions

Q. How do I update my facility’s contact information?
A. You can update your facility’s contact information at www.keproqio.com/contact. Keeping your contact information updated will enable you to receive important information from KEPRO.
Q. Can medical records be submitted electronically to KEPRO?
A. Medical records cannot be submitted electronically for appeals and quality of care reviews.

staff education about bfcc-qio services

KEPRO’s Outreach Specialists can provide value to your facility by giving you information regarding Medicare beneficiary complaints, hospital discharge and skilled service termination appeals, and Immediate Advocacy via joint presentations, quarterly staff trainings, webinars, conference calls, and advisory boards. There is no charge for their services. Visit KEPRO’s website for details.

Publication No. R146810-77-3/2020. 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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