Case Review Connections
Acute Care Edition
Issue 24: Spring 2021
Do you receive the Case Review Connections newsletter?
If not, sign up for Kepro's email list to receive important news and updates as well as the quarterly newsletter.
The Centers for Medicare & Medicaid Services (CMS) held its annual Quality Conference on March 2-3, 2021. The theme of this year’s virtual conference was Healthcare Innovation during a Time of Disruption. The conference opened with a plenary keynote by Lee Fleisher, MD, CMS Chief Medical Officer, that focused on how to turn quality data into action. He discussed how health care organizations can come out of the public health emergency well-positioned to continue improving patient safety and outcomes.
There was a session titled “Reaching the Vision: Challenges and Opportunities of Advancing Innovation and Partnership Across the Beneficiary and Family-Centered Care (BFCC) Program,” which looked at the future of the BFCC program with the goal of collectively improving the quality of care for Medicare beneficiaries. Kepro presented at a session titled “Innovations in Beneficiary and Family-Centered Care During COVID-19” discussing how Kepro has helped Medicare beneficiaries and their families during the pandemic.
With approximately 5,000 attendees, the conference had the largest gathering of health care quality leaders assembled by the federal government. The overall goal of the conference was to develop and spread solutions to address our country’s healthcare challenges.
– Jessica Whitley, MD, Medical Director
As of October 2020, CMS requires providers to send medical records to Kepro electronically. If providers are not able to comply with this requirement, they must request a waiver from Kepro. Waivers will need to be renewed every calendar year. If medical records are not sent by the approved method without a waiver, they will not be reimbursed.
Medical records for hospital discharge and skilled service termination appeals can be sent using Kepro’s online tool. You will receive a medical request from Kepro with detailed instructions.
Medical records for quality of care complaints must be submitted to the CMS Managed File Transfer (MFT) website. Your organization’s dedicated contact person will receive an email from “CMS-MFT” which may also appear as “firstname.lastname@example.org” with upload instructions. You may need to check your spam/junk mail for the email. For more information about the quality of care submission process, read: Provider Instructions for Submitting Medical Records for Quality of Care Reviews.
For more information about the electronic submission process, including waiver information, frequently asked questions, or reimbursement information,
Providing the most current staffing information helps ensure timely communication and avoid possible delays.
Unsure who Kepro has listed as your organization’s dedicated contact person?
Send an email to email@example.com to verify the information on file.
Use our online form to update your organization’s contact information.
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 contacted Kepro with concerns about the discharge plan from an acute care facility. The beneficiary was waiting on the results of an appeal, but the current discharge plan included a bed at a skilled nursing facility (SNF) where the beneficiary did not want to go. The beneficiary’s husband had passed away at that facility. The representative called Kepro and asked about Immediate Advocacy services.
The Clinical Care Coordinator (CCC) contacted the acute care facility. The CCC explained why the beneficiary did not wish to go to the SNF and asked about other discharge options. The representative was also open to home health care as long as the appropriate durable medical equipment was in place.
The CCC then received a call from the representative that the discharge was moving forward after the appeal. The CCC contacted the facility again and spoke with the facility representative about the options available. The facility representative sent a message to the beneficiary’s doctor during the call, updating him on the beneficiary’s situation. The doctor stated that since the beneficiary did not require oxygen and because she did not require a wound vac that he would agree to write discharge orders to home.
The CCC then contacted the beneficiary’s representative. The CCC stated to contact the facility if there were any questions about the discharge plan. The representative stated that he was extremely happy with the results.
One of the roles of Kepro Outreach staff is to build relationships and collaborate with other organizations that work with the senior (+65) population. The long-term care (LTC) ombudsman program is found in every state and some territories of the United States. They are valuable partners in our mission of providing information to seniors about Kepro’s services. Funded by the United States government under the Older Americans Act, the LTC ombudsman staff work to resolve problems related to the rights of individuals who live in LTC facilities, such as nursing homes, board and care homes, assisted living facilities, and other residential care communities. Below is a testimonial from the Texas Long-Term Care Ombudsman.
“The Texas Long-Term Care Ombudsman Office has proudly worked with Kepro and the organization’s Outreach Specialist for over five years. Kepro has continuously provided education and outreach to the staff that serves the state office and the local ombudsman offices. These Outreach Specialists have come to attend and present at quarterly staff training and yearly conferences to over 75 state and local ombudsman. The Kepro Outreach Specialist is also always available to answer questions that arise from the many Medicare beneficiaries from across the state. Our ombudsman are grateful for Kepro and the willingness to ensure that we provide Medicare beneficiaries with the most up-to-date and correct information when filing appeals, understanding the complaint process, and requesting Immediate Advocacy.”
– Texas Long-Term Care Ombudsman
We would like to thank our subscribers for helping us reach the milestone of 4,000 subscribers.
Publication No. R146810-174-4/2021. 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.