The Quality Improvement Organization (QIO) Program is the cornerstone of Medicare’s efforts to improve the quality of care and health outcomes for beneficiaries. KEPRO is the Beneficiary and Family Centered Care QIO (BFCC-QIO) for 29 states. We offer information regarding beneficiary complaints, hospital discharge and skilled service termination appeals, and Immediate Advocacy. 

Attention Healthcare Providers: KEPRO is required to use the Centers for Medicare & Medicaid Services (CMS) designated case review system – QMARS – for appeals case reviews. From approximately 6 pm ET Monday (2/17) through 12:22 pm ET Tuesday (2/18), KEPRO did not receive medical record faxes for appeals cases. This disruption was associated with an outside vendor, and to date, KEPRO is not aware of the root cause.

If you sent a medical record during this time frame, please fax it again to the appropriate toll-free fax number listed on the medical record request. We will do our best not to make an administrative “disagree” decision due to missing documentation. Our appeals team will do its very best to try to mitigate any delays due to this disruption, which was outside of KEPRO’s control.

We are aware that there have been delays, due to this QMARS transition, including long wait times. We are working diligently to resolve any issues and appreciate your patience and cooperation during this time.

CMS made changes to the Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) forms and is requiring providers to begin using the new forms by April 1, 2020. Please visit our appeals page for more information.

action items for healthcare providers

The Centers for Medicare & Medicaid Services (CMS) recently restructured the BFCC-QIO’s coverage area. If you are a provider in one of the areas shaded above in the map, you will need to take the following actions:

1. Update Your Appeals Notices
   Acute care providers will need to update the Important Message from Medicare, and post-acute providers will need to update the Notice of Medicare Non-coverage with KEPRO’s phone number for your region. Please note that it is acceptable to use labels to cover the existing BFCC information on the appeals notices.
   
   
2. Complete a Memorandum of Agreement (MOA) and Provider Update Form
   Visit www.keproqio.com/moa to complete the MOA and Provider Update Form. All providers are required to complete a new MOA, even if one was submitted in 2014.

For information about the availability of auxiliary aids and services, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html This website has been designed to comply with Section 508 of the U.S. Rehabilitation Act. If you have a disability and have trouble accessing information on any of these pages, please call the Helpline.