Case Review Connections
A Newsletter for Healthcare Providers and Stakeholders
Acute Care Edition
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If you want to communicate BFCC-QIO information, please email 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.
This podcast looks at the reasons why we need to prevent falls in the senior population, some of the most common causes of falls, and how to prevent them. Join our guest, Dr. Swati Guar, to learn more about this important topic.
Learn about glaucoma. Glaucoma has no early symptoms. There’s no cure for glaucoma, but early treatment can often stop the damage and protect vision.
Read more from the National Eye Institute: www.nei.nih.gov
Watch videos from the National Eye Institute to learn more about glaucoma.
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. Throughout the country, our peer reviewers work to ensure that quality standards are met and that timely decisions are made. The peer reviewers follow evidence-based medical practice and utilization guidelines from the Centers for Medicare & Medicaid Services (CMS) to ensure accurate reviews. To make sure our peer reviewers are up to date about the latest guidelines, we focus on education, which consists of three primary modes: web portal, conference calls, and one-on-one feedback. Additionally, our medical directors oversee the peer review process, and the oversight process includes inter-rater reliability (IRR), monthly review audits, and tracking and trending.
Our peer reviewers are involved with three types of reviews with the BFCC-QIO: discharge and skilled service termination appeals, quality of care complaints, and EMTALA reviews. Kepro’s qualified peer reviewers must meet the following federal regulations:
- Must be a doctor of medicine, osteopathy, dentistry, podiatry, or optometry, or another individual who is authorized under federal or state law to practice medicine, surgery, osteopathy, dentistry, podiatry, or optometry
- Have a current state license
- Are board-certified
- Must either be engaged in active practice in the state or be military physicians who actively practice in a military or Department of Veterans Affairs (DVA) healthcare facility. Active practice means that the physician usually practices (on a routine basis) a minimum of 20 hours per week. Active practice must also include active staff privileges in a healthcare facility on a regular basis. (There are some exceptions to this requirement, notably that emergency department physicians and dentists who do not have admitting privileges in an acute care hospital can meet the requirement of active staff privileges as defined in this regulation.)
If you would like more information about our peer reviewers or would like to become a peer reviewer, please visit Kepro's website.
Kepro held an appeals webinar on Tuesday, November 28, 2023. It was very well attended! At the end, a question and answer session took place for providers. Many questions were about the appeals process, so we placed that information on our website.
Just a reminder, don't miss our educational videos! Kepro has video tutorials to explain how to fill out all the notices that are processed in appeals. They have step-by-step instructions, so please check them out.
Below are a few videos that may be of interest to providers:
Kepro has recently updated the Spanish webpage on our website. New resources for this community have been added. These include several videos, a poster, a wallet card, a flyer, and more. If you work with the Spanish-speaking population, please take a look.
CMS recently released a report in November 2023, Rural-Urban Disparities in Health Care in Medicare. The report highlights some of the differences between rural and urban in healthcare experiences and how differences in quality of care vary by race and ethnicity. This report can provide some valuable information for providers related to health equity.
You may notice some changes to the email addresses, moving to acentra.com. Kepro recently became a part of the Acentra Health family. We do not anticipate any other changes at this time and will advise in the future of any potential changes required.
Publication No. R146810-338-1/2024. 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.