Working With Healthcare Providers
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!
- Beneficiary Complaints
- Other Reviews
- FAQ (PDF)
- Physician Acknowledgement Monitoring
- QIO Liaison
- Memorandum of Agreement
- Update Your Contact Information
- Become a Physician Reviewer
- Case Status Check
newsletters and special bulletins
overviewKepro is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for 29 states. As part of the BFCC-QIO contract with the Centers for Medicare & Medicaid Services (CMS), Kepro provides free services to people who have Medicare including:
- hospital discharge and skilled service termination appeals,
- quality of care reviews, and
- Immediate Advocacy.
BFCC-QIOs are part of the QIO Program, which is one of the largest federal programs dedicated to improving health quality for people who have Medicare. The mission of the QIO Program is to improve the effectiveness, efficiency, economy, and quality of services delivered to people who have Medicare. Read more about the QIO program on the CMS website.
how kepro works with healthcare providers
Kepro reviews Medicare hospital discharge and skilled service termination appeals and quality of care reviews. Cases are referred to us for a quality of care review from a variety of sources including people with Medicare (e.g., Medicare patients) and their families or representatives, CMS, and Medicare Administrative Contractors (MACs).
The QIO Liaison at your facility will distribute written information from Kepro to the appropriate department or administrative leader. Be sure your facility’s contact information is up to date, so you don’t miss any important communication from Kepro.
Kepro is also responsible for monitoring physician acknowledgement statements for hospitals. Because hospitals are paid under the prospective payment system based on the physician's diagnoses, all newly credentialed physicians must sign a statement that remains on file at the facility before their first admission to the hospital or first claim submission.
action items for healthcare providers
- Be sure your facility’s contact information is up to date, so you don’t miss any important communication from Kepro. Your facility can change the designated QIO Liaison at any time by notifying Kepro in writing.
- Providers need to communicate physician acknowledgement statements to Kepro annually.
- Use the online case status check tool to check the status for your appeal cases.
technical denial policy
Pursuant to 42 C.F.R. § 476.90, as amended on August 31, 2012, at 77 Federal Register pages 53258, 53664-665, 53682-683, the BFCC-QIOs’ authority to issue technical denials applies to providers or practitioners of any kind, regardless of setting, when they do not submit the medical records requested. The regulations also indicate that those providers and practitioners that refuse to allow a BFCC-QIO “to enter and perform the duties and functions required under its contract with CMS” may also be subject to a technical denial. Therefore, a BFCC-QIO may impose a technical denial where providers and practitioners do not comply with the requirements for case review as opposed to simply failing to submit medical records.