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Appeals 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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cms beneficiary notices initiative (bni): what's new
On January 23, 2023, the Centers for Medicare & Medicare Services (CMS) announced that the Office of Management and Budget approved updated versions of beneficiary notices.
Healthcare providers must start using the new versions of the following forms no later than April 27, 2023:
- Important Message from Medicare (CMS-10065)
- Detailed Notice of Discharge (CMS-10066)
- Medicare Outpatient Observation Notice (CMS-10611)
The updated versions, as well as general information on the notices, are available at the following links. Announcements include email addresses where questions can be sent.
- Medicare Outpatient Observation Notice (MOON)
- Important Message from Medicare (IM) and Detailed Notice of Discharge (DND)
appeal notifications and determinations
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 and determinations will be faxed to the number used for the medical record request.
Please contact Kepro with any questions. Find the toll-free number for your state at www.keproqio.com/contactus.
reminders
- Keep your organization’s contact information up-to-date. This will help you receive timely communications without unnecessary delays. Visit www.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: www.keproqio.com/casestatus
medical record electronic submission
Effective October 1, 2020, the Centers for Medicare & Medicaid Services (CMS) requires providers to send medical records to Kepro electronically.
Read more about the medical record submission process: www.keproqio.com/medicalrecords.
hospital discharge appeals
cms final rule
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 the Important Message from Medicare (IM) to inform all Medicare inpatients, including Medicare Advantage enrollees, Medicare as a Secondary Payor (MSP), and dual-eligible patients about their hospital discharge appeal rights.
Hospitals are required to give a Detailed Notice of Discharge (DND) to patients who choose to appeal a discharge decision. The DND outlines the specific reasons for discharge and applicable Medicare coverage guidelines.
Current versions of the Important Message from Medicare (IM), Form CMS-10065, and the Detailed Notice of Discharge (DND), Form CMS-10066, are posted on the Hospital Discharge Appeal Notices page of the CMS website under Downloads.
hospital requested review (hrr)
HINN 10, also known as the Notice of Hospital Requested Review (HRR), should be issued by hospitals to patients with 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 patients that have Medicare are required to notify them 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 Notice of Medicare Non-Coverage to Medicare patients (including those patients with a Medicare Advantage plan) to alert them that a Medicare-covered item or service is ending and give patients 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.
links
- Update Your Contact Information to avoid missing any communications from Kepro regarding discharge appeals and service terminations.
- The CMS website includes information about the Beneficiary Notices Initiative, including information on notices mentioned on this page and the download of forms.
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 TTY* 711 Toll-free Fax** Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-317-0751 TTY* 711 Toll-free Fax** Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-315-0636 TTY* 711 Toll-free Fax** Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-317-0891 TTY* 711 Toll-free Fax** Mailing Address 5201 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
Toll-free Phone 888-305-6759 TTY* 711 Toll-free Fax** Mailing Address 5700 West Kennedy Blvd. Suite 900 Tampa, FL 33609 |
*A TTY (teletypewriter) is a special device that lets people who are deaf, hard of hearing, or speech-impaired use the telephone to communicate, by allowing them to type messages back and forth to one another instead of talking and listening. A TTY is required at both ends of the conversation in order to communicate.
**Healthcare providers: Effective October 1, 2020, providers are to send medical records to Kepro electronically. Please refer to your medical record request or visit www.keproqio.com/medicalrecords for more information.
