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Case Review Connections 

Acute Care Edition

Issue 25: Summer 2021

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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.

National Immunizations Awareness Month

in this issue:

medical director's corner

Every year, the Centers for Medicare & Medicaid Services (CMS) requires Kepro to produce Annual Reports, which give information about the volume and outcomes of Kepro’s review activity. There are five reports available online, one for each of Kepro's five regions.

The first section of the report has global data followed by an appendix that contains data for each state in that Region. The report includes the total volume of reviews, the top 10 diagnoses for Medicare claims in that Region, the provider settings associated with beneficiary complaints, and the type of quality of care concerns and corresponding outcome identified during medical record reviews. Information about the outcomes of hospital discharge and skilled service termination appeals is available. There is also a section in the report about the standards of care that Peer Reviewers use to make their clinical decisions.

Immediate Advocacy is one of Kepro's services that allows our staff to intervene on behalf of a Medicare beneficiary; it has been used frequently during the pandemic. The report includes Immediate Advocacy success stories and shares collaborations by our Outreach staff.  The collective data in these reports is used to assist with improving the quality of care that Medicare beneficiaries receive throughout the provider system.

Get the report for your region.

appeals: the preadmission/admission hinn

The Preadmission/Admission HINN (HINN 1) notice should be given to beneficiaries when the hospital has determined that the beneficiary’s hospital services will not be covered by Medicare. The notice informs the beneficiary of his/her right to request a review of this decision. The Preadmission HINN is usually delivered before the beneficiary arrives at the hospital.  If the Admission HINN is given prior to 3 pm local time, then the beneficiary’s liability starts on the date they arrive. However, if the notice is given after 3 pm local time, liability would begin on the next day.

Kepro recently released two new YouTube videos related to HINN notices: 

  • The HINN 1 Instructional video offers a tutorial for providers about how to fill out and deliver the HINN 1 notice.
  • The HINN 10 Instructional video offers a tutorial for providers regarding how to fill out and deliver the HINN 10 notice (which is given when the hospital and doctor disagree on discharge).

Be sure to subscribe to our YouTube channel to receive notification of new videos.

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 beneficiary’s representative contacted Kepro with concerns about her mother’s medical condition. They had visited the urologist recently, and the staff did not check her Foley, due to not enough staff. The representative then took her to the emergency room, but she was not admitted. The next day, the mother woke up with horrible pain in her abdomen in the area where she had the catheter. The representative drove two hours to another hospital and requested that Kepro’s Clinical Care Coordinator (CCC) intervene with the hospital staff.

The CCC contacted the hospital and spoke with the nurse. She explained that the daughter was very concerned about her mother’s treatment. The nurse requested that the daughter contact her regarding the mother’s medications and allergies. The CCC then contacted the daughter and asked her to call the nurse. After the call with the nurse, the daughter said the hospital staff was still not giving her information. The CCC contacted the hospital again and spoke with the case manager. The CCC was told that the mother had a very bad urinary tract infection and that she was being treated with IV antibiotics. She also had been admitted to the hospital. The CCC contacted the daughter to tell her that her mother had been admitted. She was very appreciative of the help received from Kepro.

news insert to help you share medicare rights information

Kepro has advocacy resources available to help educate Medicare beneficiaries about their Medicare rights. This helps to ensure that they get the healthcare services they need and also to make sure that the care they receive is appropriate. Kepro's news insert will help you share information in your newsletter and on your website. A short and long version is available, so choose the one that will best suit the needs of your organization. 

short stay and higher weighted drg reviews

Livanta was recently awarded a national contract for Short Stay and Higher Weighted Diagnosis-Related Group (HWDRG) reviews. Livanta will be performing these reviews for all states and territories, but Kepro will remain as the BFCC-QIO for Regions 1,4,6,8, and 10 for quality of care reviews and appeals. For more information about the Short Stay and HWDRG reviews, visit Livanta’s website.

covid-19 resources

Kepro has a webpage with COVID-19 resources from CMS and the Centers for Disease Control and Prevention. Resources include tool kits, fact sheets, weblinks, and trainings.

rural health – overcoming challenges

Rural health is a continuing area of focus for CMS. Some of the challenges for rural health include hospital closures and practitioner shortages. With that in mind, CMS recently summarized their initiatives to address these issues as well as sharing accomplishments in Rethinking Rural Health, 2020 Year in Review.

outreach: healthcare provider associations

One of the roles of Kepro Outreach staff is to build relationships and collaborate with provider associations, including hospital, skilled nursing and home health, and hospice associations. These organizations help distribute timely BFCC information to their providers to ensure that providers are kept up with the necessary information needed to do their jobs. An example of this would be when CMS recently switched to electronic medical record submission. Provider associations were very helpful in getting the message out.

“SCHA and the member hospital case management staff have experienced a phenomenal working relationship with Kepro. The team has always willingly participated on teleconferences to address new processes as well as issues encountered with the review process for inpatients. We feel very fortunate to work with such a professional organization and hope to continue the process ensuring the best for all SC Medicare beneficiaries.”

- South Carolina Hospital Association

"The Texas Health Care Association has worked collaboratively with Kepro and the Outreach Specialist for more than four years. Kepro has continuously provided education and outreach to our providers who are members of our association. The Outreach Specialist has also worked closely with the THCA staff to ensure that we are always “in the know” with vital information to send out to providers when changes occur. In the past, Kepro has attended and presented at the THCA summer conferences that host over 500 providers from all over the state. However, with the rise of the pandemic, Kepro has continued these educational efforts virtually through webinar presentations and conference calls. The Kepro Outreach Specialist's willingness to answer and mitigate questions that may arise from various providers shows that Kepro is trying to ensure that providers and beneficiaries have accurate and up-to-date information."

- Texas Health Care Association

Does your staff need to learn more about Kepro services?

Visit our Schedule a Speaker page to request a presentation and contact information for the Outreach Specialist for your region.

join us for a webinar

Join our Outreach staff for an informative webinar about Kepro on September 22, 2021. The webinar will provide basic information about the services that Kepro offers for Medicare beneficiaries:

  • Quality of care complaints,
  • Appeals, and
  • Immediate Advocacy services.

Registration: September 22, 2021

If you have difficulty registering, please email QIOCommunications@kepro.com

Publication No. R146810-212-7/2021. 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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