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Case Review Connections 

Post-acute Care Edition

Issue 20: Spring 2020



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:

Medical Director's Corner An Immediate Advocacy Success Story
COVID-19 Guidance for Providers Frequently Asked Questions
Appeals Staff Education about BFCC-QIO Services

medical director's corner

The Centers for Medicare & Medicaid Services (CMS) Quality Conference was held recently from February 25 – 27, 2020, in Baltimore, Maryland. The goal of the conference was to “convene leaders across the health care spectrum, to explore how patients, advocates, providers, researchers, and champions in health care quality improvement can develop and spread solutions to address America’s most pervasive health system challenges.” There were three plenary sessions that are available for viewing. The Twitter feed is also available at #CMSQualCon20. Some of the topics that were covered include:

  • Advancing Person-Centered Care/Patients over Paperwork
  • Addressing the Opioid Epidemic and Patient Safety
  • Targeted Focus of Rural Health and Underserved Populations
  • Fostering Innovation Remarks from Seema Verma, the CMS Administrator, are also available.

If you are interested in more information about the conference, please visit www.cmsqualityconference.com.

covid-19 guidance for providers

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. CMS also has a webpage dedicated to information about the virus, including all of their press releases. A Virtual Toolkit is available to help you stay up-to-date on CMS materials.

appeals

Please include the medical record request sheet containing the barcode when faxing medical records. This automatically attaches your medical records to the case, which decreases the turnaround time on reviews.

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.

A Medicare beneficiary’s representative was concerned about a bill from the skilled nursing facility. The beneficiary had won her appeal, due to an invalid notice, but the facility was charging them for a private pay stay. The representative contacted KEPRO for assistance.

The Clinical Care Coordinator (CCC) contacted the Social Services department at the facility. She explained that the beneficiary had won the appeal and should not be charged. The facility staff member stated that as soon as she received that information in writing that she would be able to reimburse the beneficiary. KEPRO’s appeals department faxed over the information to the facility, and the beneficiary’s representative was very pleased with the outcome.

frequently asked questions

Q. How do I update my facility’s contact information?
A. You can update your facility’s contact information at www.keproqio.com/contact. Keeping your contact information updated will enable you to receive important information from KEPRO.
Q. Can medical records be submitted electronically to KEPRO?
A. Medical records cannot be submitted electronically for appeals and quality of care reviews.

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. R146810-78-3/2020. 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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