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Case Review Connections 

Post-acute Care Edition

Issue 21: Summer 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
A Reminder About Appeals Cases Frequently Asked Questions
Updates from CMS Related to Covid-19 Staff Education about BFCC-QIO Services

medical director's corner

The Centers for Medicare & Medicaid Services (CMS) requires the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) to produce an Annual Report. This report provides information about the volume and outcomes of Kepro’s review activity. It must be shared with the public, so it is posted on Kepro’s website. I would like to share with you some of the information that is available in these reports.

Each of Kepro’s five Regions must prepare an Annual Report; The first section of the report has global data with an appendix that contains data for each state in that Region. The report contains information about the total volume of reviews, the top 10 diagnoses for claims in that area, the provider settings associated with beneficiary complaints, the category of quality of care concerns identified during medical record reviews along with the corresponding outcome, and information about the outcomes of discharge appeals and service terminations.

Kepro also shares information about the standards of care that are used to make decisions in beneficiary complaints and appeals. When a medical record review is not required, Kepro may use a process called Immediate Advocacy, to assist on the behalf of a beneficiary. The report states the number of concerns that have been resolved through Immediate Advocacy. The report also provides the volume of telephone calls that are received by Kepro. I hope that this information will provide a more complete picture of Kepro’s work, as we strive to improve the quality, safety, and value of care that the Medicare beneficiary receives.

a reminder about appeals cases

Please continue to fax medical records to 844-878-7921 at this time. CMS has not given Kepro a date to return to the CMS’ designated case review system, QMARS, so those fax numbers are not currently operational. Cases are processed in a timelier manner if the correct fax number is used.

Also remember to send the cover page with the bar code, which also facilitates a faster turnaround for cases.

updates from cms related to covid-19

For the latest updates from CMS related to COVID-19, visit the CMS Emergency website. This site has all the latest memos and guidance for healthcare providers. The CMS Newsroom also puts out press releases that may be of interest to providers.

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’s representative called Kepro with concerns about her problems contacting her mother at the skilled nursing facility (SNF). Family members had tried to keep in touch with the patient but had trouble doing so. She called Kepro for assistance.

The Clinical Care Coordinator (CCC) contacted the social worker at the SNF. The social worker explained that since no one had been allowed to visit, they had been getting many phone calls. The social worker suggested that the CCC tell the family to call her between 9am and 5pm, and she would take her phone to her mother. The CCC then contacted the daughter and encouraged her to contact Kepro again if more help was needed.

frequently asked questions

Q. Where can I update my facility’s contact information?
A. Contact information can be updated at www.keproqio.com/contact using the Provider Update form.
Q. Where can I update my facility’s appeal contact?
A. Contact information can be updated at www.keproqio.com/contact using the Expedited Determinations Contact form.

staff education about bfcc-qio services

Kepro’s Outreach Specialists are available for 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. R146810-98-6/2020. 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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