Case Review Connections
Acute Care Edition
Issue 33: January 2023
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The Centers for Medicare & Medicaid Services (CMS) has updated their 2018 Rural Health Strategy to include tribal and geographically isolated communities. The new strategy is called the CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities.
One of the reasons that CMS is focusing on this population is because “people living in rural, tribal, and geographically isolated communities face barriers to accessing comprehensive, high-quality and affordable health care services.” The new strategy has six priorities:
- Priority 1: Apply a Community-Informed Geographic Lens to CMS Programs and Policies
- Priority 2: Increase Collection and Use of Standardized Data to Improve Health Care for Rural, Tribal, and Geographically Isolated Communities
- Priority 3: Strengthen and Support Health Care Professionals in Rural, Tribal, and Geographically Isolated Communities
- Priority 4: Optimize Medical and Communication Technology for Rural, Tribal, and Geographically Isolated Communities
- Priority 5: Expand Access to Comprehensive Health Care Coverage, Benefits, and Services and Supports for Individuals in Rural, Tribal, and Geographically Isolated Communities
- Priority 6: Drive Innovation and Value-Based Care in Rural, Tribal, and Geographically Isolated Communities
Within the strategy document, there are key supporting activities under each priority. One example of this is under Priority 4 where CMS will “continue to explore opportunities to enhance uptake and coverage of telehealth and other virtual services where appropriate to deliver high-quality care in rural, tribal, and geographically isolated areas.”
Read more information about the new strategy: CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities (PDF)
Starting on January 17, 2023, post-acute facilities and Medicare health plans will no longer receive phone calls for appeal notifications (when a new appeal has been filed). Post-acute facilities and Medicare health plans will receive fax notifications only.
Acute care facilities and Medicare health plans will continue to receive both appeal notification phone calls and faxes for acute appeals.
Notifications will be faxed to the number used for the medical record request.
- Keep your organization’s contact information up to date.This will help you receive appeal notifications without unnecessary delays. Visit keproqio.com/contact to update your information. If you don’t know who is listed as your organization’s point of contact, send an email to MOA@kepro.com to verify.
- Check appeal status online. Kepro’s online case status tool is always available for you to check on the status of an appeal: keproqio.com/casestatus
Whenever possible, Kepro will attempt to notify providers (Monday through Friday) if medical records are not received in a timely manner. The hope is that calls will decrease the amount of rework by providers and Kepro. When the medical record is late, a courtesy call may be made, and the review will not be closed for an hour to allow providers time to electronically submit the medical record.
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 with concerns about his hospital care. She was being told that her husband had to go on hospice because he would not recover. She was aware of his chronic conditions, but he had bounced back before when he was very sick. She contacted Kepro for assistance with the situation.
Kepro’s Clinical Care Coordinator (CCC) contacted the facility Patient Advocate. The CCC explained that the representative was getting conflicting information from different staff at the hospital. She told the Patient Advocate that the representative would like for her husband to go to the skilled nursing facility. The CCC then contacted the representative the next day and was told that the beneficiary was being transferred to the skilled nursing facility that day.
The representative stated that the beneficiary seemed to be improving, so she felt that the transfer was appropriate. The representative expressed her appreciation for the assistance to the CCC.
Kepro has added two new videos to the YouTube video library. Since Kepro serves several states with large Spanish-speaking populations, two current English videos were translated to Spanish – the Case Status Tool video (which shows how to use Kepro's Case Status tool to check the status of an appeal) and the Kepro Overview of Services (which provides a general overview of Kepro's three services: quality of care complaints, appeals, and Immediate Advocacy).
Save the Date! The CMS Quality Conference will be a virtual conference on May 1-3.
This year's theme–Building Resilient Communities: Having an Equitable Foundation for Quality Healthcare–will guide conversations and improvements around healthcare quality improvement that spark solutions to address America's health system challenges and incredible opportunities ahead.
Registration opens in January.
Publication No. R146810-287-1/2023. 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.