Case Review Connections
Acute Care Edition
Issue 23: Winter 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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article: bfcc-qios respond to covid
BFCC-QIOs Respond to COVID-19 with Information and Support for Beneficiaries. Learn more about their response.
Kepro now has a YouTube channel! Be sure to subscribe as new educational videos will be coming soon. The first three upcoming videos will have tips for providers related to the Kepro appeals process.
In this issue:
One of the roles of the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) is to review quality of care concerns. These concerns may come from a beneficiary complaint, but they also may come up during other types of reviews, such as appeals or referrals. When a potential quality of care concern is identified, the provider or practitioner will be given an opportunity to respond before a concern is confirmed. Please know that the quality review is done in a spirit of collegiality and quality improvement and is not meant to be punitive. Kepro does not typically report this information to other oversight agencies, and our work product is covered under federal confidentiality regulations.
Because there is the possibility that one day you or your facility may receive a potential quality of care concern letter from the BFCC-QIO, I wanted to share some tips that will assist providers and practitioners with their response to this type of correspondence.
- Kepro sends correspondence to the address for your organization that is listed in the Medicare database. If you are aware that mail has not been sent to the correct address, please let us know, so that we may resend it. Kepro has a provider update form.
- When a provider receives an Opportunity for Discussion letter, the response can be either by telephone or via written correspondence but must be made within seven (7) calendar days of the date of the letter. Time frames must be adhered to. These time frames are provided by the Centers for Medicare & Medicaid Services (CMS), and as a CMS contractor, we must enforce them.
- Please respond to the questions as specifically as possible with the necessary clinical information, as this response will be provided to the Physician Reviewer, who will then make the determination if the concern will be resolved or confirmed. If a concern is confirmed, the provider will be notified by phone and provided with the opportunity for a reconsideration. The request for reconsideration must be made within three (3) calendar days after the phone call.
- You will be notified by the BFCC-QIO if the concern is confirmed or resolved. Cases with confirmed concerns may be addressed by either the BFCC-QIO or the Quality Innovation Network QIO (QIN-QIO) with a corrective action plan, based on the severity of the concern.
- Please take the correspondence seriously and respond in a timely manner. Visit Kepro's website for more information about the quality of care process.
You can upload medical records through Kepro's website. For those providers that are unable to send them electronically, they may still be faxed or mailed. However, a waiver is necessary for those records to be reimbursed. The waiver is available as an online form.
You may find more information about the electronic submission process, reimbursement rates, and waivers on our medical records page.
You can also watch a video to learn more: Medical Record Submission Process.
Reminder: The waiver Kepro has on file is valid through December 31, 2020. In order to maintain approval status, a new waiver must be submitted for the 2021 calendar year. Kepro started accepting waiver requests for the 2021 calendar year on December 14, 2020.
For questions related directly to waiver requests, email BFCC_Waiver_submissions@kepro.com.
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 beneficiary’s representative contacted Kepro on behalf of her husband. He was in a long-term care acute facility. Her husband had cancer, and she was concerned that the case manager at the facility was canceling his cancer care appointments. She contacted his physician who said that if the beneficiary returns to the hospital that he will provide that treatment. The case manager said they would not be able to get him transported to the hospital. The wife requested an intervention by Kepro.
The Clinical Care Coordinator (CCC) contacted the facility and spoke with the case manager. She stated that they are trying to coordinate with the doctor writing the order, so that the beneficiary can be admitted directly and not go to the emergency room. She then contacted the wife who said that after Kepro’s call that the facility is working on the transfer. The CCC then stated that she would follow up. Several days later, the CCC confirmed with the wife that the husband had been admitted to the hospital by direct admit. She thanked the CCC for her intervention and for getting the process moving along.
|Q.||My facility is not able to submit medical records electronically yet, and we are waiting on a signed waiver from Kepro. How do we send Kepro the requested medical records?|
|A.||Kepro understands that providers may not be ready for this change; for that reason, Kepro will not be turning off its fax server and will process medical records received via fax. Your facility may continue to fax medical records to Kepro; however, we will not pay for those received faxes without a signed/approved waiver.|
|Q.||What is the reimbursement rate for medical records?|
|A.||For electronic submission the reimbursement rate is $3.00 per patient record. For facsimile or mail submission (with waiver) the reimbursement rate is $0.15 per page for requested patient records (plus the cost of first class postage for mailed photocopies).|
One of the roles of Kepro Outreach staff is to build relationships and collaborate with other organizations that work with the senior (+65) population. One of the organizations that the Outreach staff frequently collaborate with is the Senior Medicare Patrols (SMP). “Senior Medicare Patrols (SMPs) empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report health care fraud, errors, and abuse through outreach, counseling, and education. SMPs are grant-funded projects of the federal U.S. Department of Health and Human Services (HHS), U.S. Administration for Community Living (ACL).”
“The Kepro BFCC-QIO has worked with the Texas SMP Director for over 4 years. The Kepro Outreach Specialist has collaborated on over 20 stakeholder and beneficiary calls, in-person, and virtual presentations throughout the duration of our working relationship. The Outreach Specialist has assisted in referrals for beneficiaries to the QIO and continues to be available for questions as they are referred.
During the rise of COVID-19, the Kepro Outreach Specialist regularly sent updates and referred the SMP to the Kepro website for continued updates. As hurricane season arose, the Kepro Outreach Specialist ensured that the SMP had important phone numbers on hand so that the SMP director had this accessible in the event of loss of power. The TX SMP looks forward to continuing collaboration with the BFCC-QIO.”
- Texas SMP
"The Massachusetts Senior Medicare Patrol (MA SMP) Program is focused on making sure quality of care is at the center of every medical intervention for every Medicare beneficiary. Kepro is an important partner in this effort.
Outreach Specialist Kia Weaver sits on the MA SMP Statewide Advisory Committee and participates fully by providing observations and suggestions to make our program stronger. The MA SMP Program routinely refers consumers to Kepro when quality of care is an issue. We look forward to exploring more avenues for partnering as we all work to ensure that Medicare beneficiaries have access to the highest quality of care."
- Massachusetts SMP
Join our Outreach staff for an informative webinar about Kepro on January 27, 2021. The webinar will cover the basic services that Kepro offers for Medicare beneficiaries:
- Beneficiary complaints
- Appeals, and
- Immediate Advocacy.
Register at the link below. If you have difficulty registering, please email QIOCommunications@kepro.com.
Registration: January 27, 2021; 1 – 2 pm ET
Publication No. R146810-149-12/2020. 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.