Case Review Connections
Acute Care Edition
Issue 30: July 2022
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Kepro has videos for healthcare providers to help with their day-to-day work and for people who have Medicare that talk about our free services.
join us for a webinar
Join our Outreach staff for an informative webinar about Kepro on Wednesday, July 27, 2022. The webinar will provide basic information about the services that Kepro offers for Medicare beneficiaries:
- Quality of care complaints,
- Appeals, and
- Immediate Advocacy services.
If you have difficulty registering, send an email to QIOCommunications@kepro.com.
july is uv awareness month
During UV Awareness Month, the focus is on the dangers of UV. Protect yourself from the sun’s harmful ultraviolet (UV) radiation while outdoors.
Read more on our UV Awareness Month page.
in this issue:
medical director's corner - jessica whitley, md, mba
The Centers for Medicare & Medicaid Services (CMS) has implemented a National Quality Strategy to “set and raise the bar for a resilient, high-value health care system that promotes quality outcomes, safety, equity, and accessibility for all individuals, especially for people in historically underserved and under-resourced communities.”
There are eight strategy goals within this initiative, and in this column, I will review the first four goals.
- Embed quality into the care journey. With this goal, quality includes ensuring optimal care and best outcomes for people of all ages and backgrounds and across settings and payer types. One of the ways that CMS measures quality is through its provider quality measures. This information can be accessed on Medicare’s compare sites.
- Advance health equity. With this goal, the objective is to eliminate any avoidable differences in health outcomes experienced by people who are disadvantaged or underserved. CMS has created a health equity fact sheet (PDF), which shares many of the ways that they are hoping to accomplish this goal.
- Foster engagement. With this goal, CMS hopes to increase engagement between individuals and their care teams to improve care and communication. CMS has created a person and family engagement (PFE) tool kit (PDF) with practical tools that providers can use to improve PFE at their facility.
- Promote safety. This goal is intended to focus on preventing healthcare errors that result in patient harm. CMS has tasked the Quality Innovation Network Quality Improvement Organizations (QIN-QIOs) to assist with improvement in this goal. More information on how the QIN-QIOs are working on patient safety is available in this fact sheet (PDF). Providers can find the QIN-QIO for their state on the QIO Program website.
CMS has created a National Quality Strategy fact sheet (PDF) that shares some of the results of the quality strategy. In an upcoming column, I will review the final four goals of the CMS National Quality Strategy.
appeals: checks being received by healthcare providers
Kepro has been receiving inquiries from providers about checks they have been receiving. Please note that Kepro, as required by the FY2021 Inpatient Prospective Payment System Final Rule, is paying the provider $3.00 for each electronically submitted medical record. On the check stub, there is a list of medical record reviews that are associated with the payment. Please see the reimbursement section of our Medical Records page for more information.
appeals: frequently asked questions
|Q.||Where can I find the instructions to fill out the Important Message from Medicare?|
|A.||Instructions can be found at the CMS Beneficiary Notices website under FFS & MA IM.|
|Q.||Is there a Spanish version of the notice?|
|A.||Yes. It can also be found at the CMS Beneficiary Notices website under FFS & MA IM. Submit questions regarding the notices at: https://appeals.lmi.org|
Kepro also has instructions on how to fill out the Important Message from Medicare on our YouTube channel.
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 beneficiary contacted Kepro with concerns about a hospital bill from two years prior. She had received care for COVID-19, and they were billing her two years later. The facility stated the delay was due to COVID-19. She requested help from Kepro regarding the situation and the possibility of a payment plan.
The Clinical Care Coordinator (CCC) contacted the facility and was transferred to the billing supervisor. She stated that they would be calling the beneficiary regarding payment arrangements. The CCC contacted the beneficiary with that information. The CCC then received another call from the facility and was told that the accounts were billed to the beneficiary in error, so the beneficiary would not be billed at all. The CCC contacted the beneficiary who was appreciative for the Kepro intervention.
health equity report
CMS has compiled data related to Medicare Advantage plans and disparities. “This report presents summary information on the quality of health care received by Medicare Advantage enrollees nationwide (42 percent of all people with Medicare in 2021).
The report highlights (1) racial and ethnic differences in health care experiences and clinical care, (2) differences in health care experiences and clinical care by sex, and (3) how racial and ethnic differences in quality of care vary by sex.”
introducing kepro's aging health matters podcast
People who have Medicare get tips that can help on their healthcare journeys. Your podcast host - Kepro - is joined by guests to have open conversations that are aimed at making life a little bit easier.
For more information about the podcast or to listen to an episode, visit Kepro's podcast page or search "Aging Health Matters" wherever you listen to podcasts.
Kepro’s Outreach Specialists are available for joint presentations, quarterly staff trainings, webinars, conference calls, and advisory boards. There is no charge for this service. Visit Kepro's Schedule a Speaker page for details.
We also have resources available to educate about Kepro’s services.
Publication No. R146810-249-7/2022. 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.