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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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red emblem to indicate important information  medical record electronic submission

Effective October 1, 2020, the Centers for Medicare & Medicaid Services (CMS) requires providers to send medical records to Kepro electronically.

Read more about the medical record submission process: www.keproqio.com/medicalrecords.

quality of care reviews

Medical record review is the traditional option to resolve a quality of care complaint under Medicare. This is at no cost to the beneficiary (e.g., Medicare patient).

When Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), receives a written complaint about the quality of services received by a Medicare beneficiary, Kepro will request a copy of the medical record. A doctor of matching specialty will review the medical record. The review process could take four to six weeks to complete, during which the BFCC-QIO will keep the person who made the complaint informed of the progress of the review. When the review is complete, the BFCC-QIO notifies that person of the final result the complaint.

When review confirms a quality concern, it is referred to the Quality Innovation Network Quality Improvement Organization (QIN-QIO) for quality improvement activities and to engage healthcare providers in making system changes to prevent a similar problem from occurring in the future.

Beneficiary Complaint Process Flow Chart (PDF)




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