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KEPRO - Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO)
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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!

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update

With the changes to the BFCC-QIOs, please note that it is acceptable for providers and/or Medicare health plans to use labels with the updated BFCC-QIO information covering the pre-printed existing BFCC-QIO contact information on the Notice of Medicare Non-coverage and the Important Message from Medicare. 

The Centers for Medicare & Medicaid Services (CMS) has just implemented a Beneficiary Notices Initiative (BNI) mailbox portal for beneficiary notices and related policy questions.

hospital discharge appeals

On November 27, 2006, CMS published a final rule, CMS-4105-F: Notification of Hospital Discharge Appeal Rights. Beginning July 1, 2007, hospitals must deliver a revised version of the Important Message from Medicare (IM) to inform all Medicare beneficiaries who are hospital inpatients, including MA enrollees, Medicare as a Secondary Payor (MSP), and dual-eligible beneficiaries about their hospital discharge appeal rights.

CMS has provided guidelines regarding the delivery of the initial follow-up IM along with communication specifications regarding the size of the notice. Beneficiaries who choose to appeal a discharge decision will receive a more detailed notice outlining the rationale and applicable Medicare Coverage guidelines for such a decision.

Hospital Requested Review (HRR)
HINN 10, also known as the Notice of Hospital Requested Review (HRR), should be issued by hospitals to beneficiaries in Original Medicare whenever a hospital requests a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) review of a discharge decision without physician concurrence. To initiate an HRR, the hospital staff should call KEPRO, and then electronically send the medical record. HRRs are completed Monday - Friday and will be completed within two business days of the receipt of all pertinent information requested.

expedited determinations

Home health agencies (HHAs), skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), and hospices with beneficiaries in Fee-For-Service Medicare are required to notify beneficiaries of their right to an expedited review process when these providers anticipate that Medicare coverage of their services will end.

HHAs, SNFs, hospices, CORFs, and swing beds (under instruction) are required to provide a Generic Notice to beneficiaries to alert them that a Medicare-covered item or service is ending and give beneficiaries the opportunity to request an expedited determination from a BFCC-QIO. A Detailed Notice is given when the BFCC-QIO review is requested in order to provide more explanation on why coverage is ending.

Under the MA program, HHAs, SNFs, and CORFs are required to provide a Notice of Medicare Non-Coverage to beneficiaries to alert them that a Medicare covered item or service is ending and give enrollees the opportunity to request an expedited determination from a BFCC-QIO. A Detailed Notice is given when the BFCC-QIO review is requested in order to provide more explanation on why coverage is ending.

contact information

Telephone, Fax Numbers and Mailing Addresses
Region 1
Connecticut
Massachusetts
Maine
New Hampshire
Rhode Island
Vermont
Region 4
Alabama
Florida
Georgia
Kentucky
Mississippi
North Carolina
South Carolina
Tennessee
Region 6
Arkansas
Louisiana
New Mexico
Oklahoma
Texas
Region 8
Colorado
Montana
North Dakota
South Dakota
Utah
Wyoming
Region 10
Alaska
Idaho
Oregon
Washington
Toll-free Phone
888-319-8452

Local Phone
216-447-9604

TTY
855-843-4776

Toll-free Fax
844-878-7921

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131
Toll-free Phone
888-317-0751

Local Phone
813-280-8256

TTY
855-843-4776

Toll-free Fax
844-878-7921

Mailing Address
5201 West Kennedy Blvd.
Suite 900
Tampa, FL 33609
Toll-free Phone
888-315-0636

Local Phone
813-280-8256

TTY
855-843-4776

Toll-free Fax
844-878-7921

Mailing Address
5201 West Kennedy Blvd.
Suite 900
Tampa, FL 33609
Toll-free Phone
888-317-0891

Local Phone
216-447-9604

TTY
855-843-4776

Toll-free Fax
844-878-7921

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131
Toll-free Phone
888-305-6759

Local Phone
216-447-9604

TTY
855-843-4776

Toll-free Fax
844-878-7921

Mailing Address
5700 Lombardo Center Dr.
Suite 100
Seven Hills, OH 44131




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