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Case Review Connections A Newsletter for Healthcare Providers and Stakeholders Post-acute Care Edition Issue 34: March 2023 Do you receive the Case Review Connections newsletter? If not, sign up for Kepro's email list to receive important news and updates as well as the bi-monthly newsletter. |
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.
join us for a webinar
Join our Outreach staff for an informative webinar about Kepro on Wednesday, March 29, 2023. The webinar will provide basic information about the services that Kepro offers for Medicare beneficiaries:
- Quality of care complaints,
- Appeals, and
- Immediate Advocacy services.
If you have difficulty registering, send an email to QIOCommunications@kepro.com.
march is national nutrition month
Get information and resources you can share with your patients and community:
www.keproqio.com/nutritionmonth
in this issue:
medical director's corner - jessica whitley, md, mba
Healthcare providers have the responsibility of issuing notices to Medicare beneficiaries (or sometimes their families) that describe their appeal rights. Many people have questions about the appeal process, as it may be something they have never done before.
Kepro has put together some videos to assist staff, as they are tasked with assisting patients. There is currently a video for beneficiaries (called Do you have Medicare? Learn how to file an appeal.) describing the appeal process, which has been very popular. In February, Kepro did a podcast episode (Kepro’s Aging Health Matters podcast) with me and our Director of Operations for Appeals, Rose Hartnett, as the guests. In the podcast, Rose and I describe the process of a medical record review, the types of things that physicians are looking at during the appeal, and some of the qualifications of our peer reviewers. This provides some more in-depth information than the beneficiary appeal video. So if patients are looking for just a quick overview, point them to the beneficiary appeals video. If they are looking for a more comprehensive view of the process, the new podcast will provide them with a lot of information, to help navigate while they are going through the appeal.
I hope that providers will find these appeals tools useful, as Kepro hopes to give you patient education resources that will make things easier for both providers and Medicare beneficiaries. Our video library has valuable information for both providers and Medicare beneficiaries.
appeals: reminder
Post-acute facilities and Medicare health plans will no longer receive phone calls for appeal notifications (when a new appeal has been filed). Post-acute facilities and Medicare health plans will receive fax notifications only.
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 beneficiary contacted Kepro with concerns about a bill from the skilled nursing facility. He tried to contact the facility to discuss the details of the bill but had not been able to get any answers. He contacted Kepro and requested assistance with finding out the specifics of his bill for $5,600.
The Kepro Clinical Care Coordinator (CCC) contacted the facility and spoke with the business office. It was determined that the beneficiary had Medicare and no secondary, so the first 20 days had no copay. After that, he was billed $194.50 per day for the copay. The CCC then contacted the beneficiary who thought he might have a secondary. The CCC told the beneficiary to check into whether he had a secondary, and if so, contact the business office with that information. The beneficiary stated that he was thankful that he had spoken to the CCC and that she was the first person to actually explain the bill to him.
covid-19 update
The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic will end on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available to help you prepare for the end of the PHE.
The following materials reflect recent changes and are currently available on the CMS Emergencies Page:
- Provider-specific fact sheets for information about COVID-19 PHE waivers and flexibilities:
https://www.cms.gov/coronavirus-waivers - CMS 1135 Waiver / Flexibility Request and Inquiry Form: https://cmsqualitysupport.servicenowservices.com/cms_1135
- Acute Hospital At Home:
https://qualitynet.cms.gov/acute-hospital-care-at-home
rural health
CMS recently awarded the first 200 of 1,000 Medicare-funded physician residency slots in hospitals serving underserved communities. For more information about this initiative, visit the CMS website.
2023 cms quality conference
The 2023 CMS Quality Conference, Building Resilient Communities: Having an Equitable Foundation for Quality Health Care, is scheduled for May 1-3, 2023.
The conference is free, and registration is now available.
Publication No. R146810-292-3/2023. 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.
