Memorandum of Agreement
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!
KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) authorized by the Medicare program to review medical services provided to Medicare beneficiaries in Areas 2,3, and 4. As you may know, we review medical records to determine whether services delivered to these beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. We also review hospital discharge appeals and termination of services appeals for Medicare beneficiaries.
In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO. MOAs outline the QIO’s and provider’s responsibilities during the review process.
Section 1866 (a)(1)(E) of the Social Security Act requires providers of services to have an agreement with QIOs to release data related to patients when a QIO requests it.
Section 1866 (a)(1)(F)(i) of the Social Security Act requires hospitals which provide inpatient hospital services paid under the Prospective Payment System (PPS) to maintain an agreement with QIOs to review the validity of diagnostic information provided by such hospitals, the completeness, adequacy and quality of care provided, the appropriateness of admissions and discharges, and the appropriateness of care provided for which additional payments are sought.
Section 1866 (a)(1)(F)(ii) of the Social Security Act requires hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), hospices, LTACs, CORFs, and home health agencies (HHAs) to maintain an agreement with a QIO to perform certain functions.
The MOA describes (a) KEPRO procedures with respect to certain contract obligations and (b) review and appeal rights providers have with respect to these obligations.
Download the MOA form and the Provider Update form and email the signed documents to KEPRO at email@example.com.* KEPRO will then return a signed copy to the provider upon completion.
*Please note that if a hospital has its own Medicare number, it needs an individual MOA.
For questions regarding MOAs, click here.
For more information about the MOA, please click here.
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