On the Healthcare Front
Issue #9: November 2022
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when should you call kepro?
- If you are not ready to be discharged from the hospital.
- If your Medicare skilled services are ending too soon. Examples of skilled services include things like physical therapy and nursing services.
- If you have a concern about the quality of care you received.
- If you have a concern about your medical care that needs to be taken care of right away.
Click on the link below for the phone number for your state. These services are free for people who have Medicare.
november is family caregivers month
Who are caregivers? A caregiver is a paid or unpaid person who helps someone with his or her activities of daily living.
Caregiving can be different for everyone. It could include helping someone by
- giving a ride to the store,
- helping with meals,
- accompanying to a doctor appointment, or
- a phone call to see how a friend or family member is doing.
Take a look at more information for caregivers: www.keproqio.com/familycaregiversmonth
medicare open enrollment
The Medicare open enrollment period is from October 15 to December 7.
On October 6, the Centers for Medicare & Medicaid Services (CMS) released 2023 Medicare Advantage and Part D star ratings to help people with Medicare compare plans.
Read the news release:
Other Medicare open enrollment information:
For people with Medicare or their caregivers who want to choose a Medicare provider (like physicians, hospitals, nursing homes, and others), this tool provides a single place to search and compare that lets you:
- Find information about providers and facilities based on your needs
- Get helpful information to choose your healthcare providers
- Make more informed decisions about where you get your health care
Find and compare nursing homes, hospitals, and other providers near you:
Check out things to consider when choosing a healthcare provider:
Learn more about the types of healthcare providers:
If you have Medicare and have a concern about the health care (or related medical services) you had, you can do something about it. You can call Kepro and ask about Immediate Advocacy services. This process can be used to resolve an issue quickly.
immediate advocacy can help fix communication issues when talking to your healthcare provider doesn't fix your problem.
Sometimes patients need to stay in a skilled nursing facility to fully recover from an illness or surgery before being able to go back home safely.
Helene had a bad hip. She struggled for several years with pain whenever she did a good deal of walking. Finally, she had enough. She spent some time in the hospital getting hip surgery (a new hip), which is a major surgery. As part of the patient’s recovery, she needed time – at least a few weeks – to fully recover before going home.
During Helene’s time at the skilled nursing facility, she made improvements and was almost ready to go home. But, she started having issues with her diabetes. She thought that she would be able to stay at the skilled nursing facility for a few more days to straighten things out. However, the staff told her that she would be discharged in a couple of days.
As part of the discharge process, the skilled nursing facility gave Helene (the Medicare patient) a Notice of Medicare Non-Coverage (NOMNC) that said when Medicare would stop paying for her care at the facility. Although Helene wanted to go home, she felt like she wasn’t ready to leave until issues with her diabetes were under control. The paperwork included information about how to stop the discharge.
The patient’s nephew called Kepro to file an appeal to enable his aunt to remain at the facility. The patient won the appeal due to an invalid NOMNC notice, but the facility was charging her for a private pay stay. The patient tried to clear this up with the facility but didn’t have any luck. The patient’s nephew called Kepro again, this time to ask about Immediate Advocacy services.
Kepro spoke with staff in the social services department at the facility. Kepro explained that the patient had won the appeal and should not be charged. The staff member at the nursing facility said that as soon as she had the information in writing that she would be able to fix the billing issue. Kepro’s appeals department faxed the paperwork.
The patient and her nephew were relieved that the issue was taken care of quickly thanks to Immediate Advocacy services.
If you are on Medicare and are not happy with the care you received or if you need help working through an issue that needs to be taken care of right away, please call Kepro and ask about Immediate Advocacy services.
- Find and compare nursing homes near you: www.medicare.gov/care-compare
- More information about the Notice of Medicare Non-Coverage: www.medicare.gov
- Read about the Immediate Advocacy process: www.keproqio.com/ia
- Watch a video about Immediate Advocacy: www.youtube.com
Publication No. R146810-261-11/2022. 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.