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KEPRO - Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO)
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We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

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KEPRO's role as a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is to protect the rights of Medicare beneficiaries, preserve the Medicare Trust Fund, and improve quality of care.

We work in partnership with providers and practitioners like you across organizational, cultural, and geographic boundaries. We bring the voices of beneficiaries and families into healthcare case review activities to increase communication and improve the experience of care. We review cases for utilization, quality, and correct diagnosis-related group (DRG) assignment. Cases are referred to us for review from a variety of sources including Medicare beneficiaries and their families, the Centers for Medicare & Medicaid Services (CMS), and Medicare Administrative Contractors (MACs).

The QIO Liaison at your facility will receive notices and communications from KEPRO about its medical record review activity. Your facility can change the designated QIO Liaison at any time by notifying KEPRO in writing.

KEPRO is also responsible for monitoring physician acknowledgement statements for hospitals. Because hospitals are paid under the prospective payment system based on the physician's diagnoses, all newly credentialed physicians must sign a statement on file before their first admission to the hospital or first claim submission.

For more information about MOAs, click here.

To subscribe to KEPRO’s newsletter or access past or current issues, please click here.

For more information about the CMS Partnership for Patients Initiative, please click here. For more information about the MLN Connects provider newsletter, please click here.

QualityNet (www.qualitynet.org) is the primary source for the Hospital Inpatient Quality Reporting (HIQR) and the Hospital Outpatient Quality Reporting (HOQR) programs. Hospitals are encouraged to visit this site frequently for HIQR and HOQR Program requirements, including Annual Payment Update information for both programs. To contact the QualityNet Help Desk, please call 1-866-288-8912 or email qnetsupport@hcqis.org.

Updated Technical Denial Policy
In the past, BFCC-QIOs had the authority to issue technical denials only to hospital providers when they failed to submit requested medical records in furtherance of a BFCC-QIO review. Pursuant to 42 C.F.R. § 476.90, as amended on August 31, 2012, at 77 Federal Register pages 53258, 53664-665, 53682-683, the BFCC-QIOs’ authority to issue technical denials now applies to providers or practitioners of any kind, regardless of setting, when they do not submit the medical records requested. The regulations also indicate that those providers and practitioners that refuse to allow a BFCC-QIO “to enter and perform the duties and functions required under its contract with CMS “may also be subject to a technical denial. Therefore, a BFCC-QIO may impose a technical denial where providers and practitioners do not comply with the requirements for case review as opposed to simply failing to submit medical records.

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