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Case Review Connections 

Acute Care Edition

Issue 20: Spring 2020, Special COVID-19 Edition

If you want to communicate BFCC-QIO information, please contact KEPRO at QIOCommunications@kepro.com and request a newsletter insert or fact sheet for your organization. Please do not copy and paste information from Case Review Connections.

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In this issue:

COVID-19 Guidance for Providers
Frequently Asked Questions
An Immediate Advocacy Success Story
Staff Education about BFCC-QIO Services

covid-19 guidance for providers

During this time of crisis, KEPRO wants to be sure that healthcare providers are aware of available resources and information. The Centers for Medicare & Medicaid Services (CMS) is providing guidance to providers regarding COVID-19. Waivers are in place including information about the three-day hospital stay prior to admission to a skilled nursing facility. A Virtual Toolkit is available to help you stay up-to-date on CMS materials. CMS has a webpage dedicated to information about the virus, including all of their press releases. The press releases include information on coverage, waivers, elective surgeries, FAQs, and telehealth.

The Centers for Disease Control includes information on their website for healthcare facilities and healthcare professionals. They have a section of their webpage dedicated to the virus with information on how to contain the spread as well as current cases by location. The government has also set up a website completely dedicated to COVID-19 at www.coronavirus.gov.

KEPRO is dedicated to continuing its provision of services with the understanding of the situation that providers and stakeholders are encountering. We wish to thank you for your commitment to Medicare beneficiaries.

frequently asked questions

Q. Does the Important Message from Medicare need to be delivered face-to-face for COVID-19 patients?
A. The facility should follow the same process it would for any other legal documents, such as Consent to Treat, surgery, etc., with a patient in isolation. The facility staff can leave the signed copy with the patient and retain a new, unsigned copy for the medical record documentation. Due to the nature of the illness, documentation will need to be made on the unsigned copy that the signed document was left in the patient’s room.
Q. Can a beneficiary appoint a representative to act on his/her behalf with regards to an appeal?
A. Yes, a beneficiary can appoint a representative. Hospitals with COVID-19 patients may want to discuss this as an option. If a representative is appointed, the notification may be made by telephone following normal procedure when a representative is involved.
Q. Is the three-day hospital stay prior to admission to a skilled nursing facility (SNF) waived due to COVID-19?
A. Yes, the three-day hospital stay is waived for SNF coverage. Please see the CMS fact sheet for details.
Q. Are providers still required to report quality data at this time?
A. CMS is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs. For more information, read the press release: CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19
Q. What information is available about coverage for COVID-19?
A. CMS has compiled two Frequently Asked Questions documents with complete coverage information, including one for regular coverage and one for catastrophic coverage.
Q. Is there information available for Medicare Advantage plans and Part D plans related to COVID-19?
A. CMS distributed a memo, Information Related to Coronavirus Disease 2019 - COVID-19, specifically for MA plans and Part D plans regarding their obligations and permissible flexibilities.
Q. Where can I find information on the Medicare telehealth benefit?
A. Medicare telehealth benefits have been expanded due to COVID-19.

immediate advocacy success story

Immediate Advocacy is an informal process in which the BFCC-QIO acts as a liaison for people with Medicare to quickly resolve an oral complaint. KEPRO would like to share success stories with providers to show how Immediate Advocacy can benefit providers by resolving problems quickly, which leads to improved patient relations.

Providers and Medicare beneficiaries can also take advantage of this service during the COVID-19 emergency. KEPRO can provide assistance to beneficiaries who need prescription assistance, information, or guidance. Providers can refer them to KEPRO for this type of assistance.

A Medicare patient was concerned about her hospital discharge because two physicians gave her different information. She was told by her attending physician that she was not being discharged, but the covering physician came in later that day and told her that she was. The patient then asked the nurse, who also said she was being discharged. The staff provided no discharge instructions of any kind, no prescriptions, and no information about her follow-up appointments at discharge. The patient called KEPRO for assistance.

The Clinical Care Coordinator (CCC) from KEPRO contacted the hospital and spoke with the charge nurse. She stated that she would review the patient’s discharge information and go over everything with her. The CCC then called the patient to let her know that the charge nurse would be following up with her that day.

staff education about bfcc-qio services

KEPRO’s Outreach Specialists can provide value to your facility by giving you information regarding Medicare beneficiary complaints, hospital discharge and skilled service termination appeals, and Immediate Advocacy via joint presentations, quarterly staff trainings, webinars, conference calls, and advisory boards. There is no charge for their services. Visit KEPRO’s website for details.

Publication No. XXXX-XXX-XX/2020. 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. 

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