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KEPRO - Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO)
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healthcare professional Memorandum of Agreement
We are the Medicare Quality Improvement Organization, working to improve the quality of care for Medicare beneficiaries. Our site offers beneficiary and family-centered care information for providers, patients, and families. Welcome!

update

Effective June 8, 2019, KEPRO will be the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) in Alabama, Alaska, Arkansas, Colorado, Connecticut, Florida, Georgia, Idaho, Kentucky, Louisiana, Maine, Massachusetts, Mississippi, Montana, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, and Wyoming. If your facility is located in one of these states, a new MOA form will need to be completed.

The MOA form will be available for electronic submission on June 8, 2019. For updates about the MOA process, please sign up for our email distribution list. If you have any questions about the MOA process, please send an email to moa.kepro@hcqis.org.

If your facility is NOT within the 29 states listed above, Livanta will be your new BFCC-QIO effective June 8, 2019. Please reach out to them with any questions or concerns you have in regards to your organization’s MOA.

documents

KEPRO MOA Frequently Asked Questions (PDF)

CMS Regulations (PDF)

background

KEPRO is authorized by the Medicare program to review medical services provided to Medicare beneficiaries. As you may know, we review medical records to determine whether services delivered to these beneficiaries meet medically acceptable standards of care, are medically necessary, and are delivered in the most appropriate setting. We also review hospital discharge appeals and termination of services appeals for Medicare beneficiaries.

In order to participate in the Medicare program, certain providers are required under federal law to have a Memorandum of Agreement (MOA) with a QIO. MOAs outline the QIO’s and provider’s responsibilities during the review process.

Section 1866 (a)(1)(E) of the Social Security Act requires providers of services to have an agreement with QIOs to release data related to patients when a QIO requests it.

Section 1866 (a)(1)(F)(i) of the Social Security Act requires hospitals which provide inpatient hospital services paid under the Prospective Payment System (PPS) to maintain an agreement with QIOs to review the validity of diagnostic information provided by such hospitals, the completeness, adequacy and quality of care provided, the appropriateness of admissions and discharges, and the appropriateness of care provided for which additional payments are sought.

Section 1866 (a)(1)(F)(ii) of the Social Security Act requires hospitals, critical access hospitals (CAHs), skilled nursing facilities (SNFs), hospices, LTACs, CORFs, and home health agencies (HHAs) to maintain an agreement with a QIO to perform certain functions.

The MOA describes (a) KEPRO procedures with respect to certain contract obligations and (b) review and appeal rights providers have with respect to these obligations.




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