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In this issue:

medical director's corner

The Centers for Medicare & Medicaid Services (CMS) requires the Beneficiary and Family Centered Care Quality Improvement Organizations (BFCC-QIOs) to produce an Annual Report. This report provides information about the volume and outcomes of Kepro's review activity. It must be shared with the public, so it is posted on Kepro's website. I would like to share with you some of the information that is available in these reports.

Each of Kepro’s five Regions must prepare an Annual Report; The first section of the report has global data with an appendix that contains data for each state in that Region. The report contains information about the total volume of reviews, the top 10 diagnoses for claims in that area, the provider settings associated with beneficiary complaints, the category of quality of care concerns identified during medical record reviews along with the corresponding outcome, and information about the outcomes of discharge appeals and service terminations.

Kepro also shares information about the standards of care that are used to make decisions in beneficiary complaints and appeals. When a medical record review is not required, Kepro may use a process called Immediate Advocacy, to assist on the behalf of a beneficiary. The report states the number of concerns that have been resolved through Immediate Advocacy. The report also provides the volume of telephone calls that are received by Kepro. I hope that this information will provide a more complete picture of Kepro’s work, as we strive to improve the quality, safety, and value of care that the Medicare beneficiary receives.

a reminder about appeals cases

Please continue to fax medical records to 844-878-7921 at this time. CMS has not given Kepro a date to return to the CMS’ designated case review system, QMARS, so those fax numbers are not currently operational. Cases are processed in a timelier manner if the correct fax number is used.

Also remember to send the cover page with the bar code, which also facilitates a faster turnaround for cases.

updates from cms related to covid-19

For the latest updates from CMS related to COVID-19, visit the CMS Emergency website. This site has all the latest memos and guidance for healthcare providers. The CMS Newsroom also puts out press releases that may be of interest to providers.

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 patient’s husband called Kepro with concerns about his wife who was in the hospital. Because he spoke Spanish, an interpreter was involved. He told Kepro that before his wife was in the hospital, they had a friend over who tested positive for COVID-19. His wife then became ill. She had a fever, diarrhea, and didn’t feel like eating. She was taken to the emergency room, where she was tested, intubated, and admitted to the intensive care unit (ICU).

The patient’s husband was very upset over what was happening to his wife. He was having a hard time getting information from the hospital staff about her. He called Kepro to ask if we could help him to get regular updates on her condition.

A Kepro social worker talked with the chief nursing officer (CNO) from the hospital about the patient and explained how the husband was not able to get any updates about his wife’s condition from the hospital staff. The CNO said that the staff attempted to contact the family once or twice each shift. However, the hospital staff was spending most of its time taking care of patients during this crisis. She stated that she would take the husband’s concerns to the director of nursing and would have someone contact him regarding a resolution.

The husband did get a call from the hospital saying that they had put a plan in place to make sure that he would get a daily update about his wife’s condition. "Thank you for your help, Kepro. You were able to get the information that I was unable to get on my own. I feel so much better knowing what’s happening with my wife."

frequently asked questions

staff education about bfcc-qio services

Kepro’s Outreach Specialists are available for 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. R146810-97-6/2020. 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.