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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!

The Centers for Medicare & Medicaid Services (CMS) is changing the selection process for medical records for Short Stay reviews. Previously, smaller providers had a request for 10 cases, and larger institutions had a request for 25 cases. As of April 2017, this process changed. CMS will sample the top 175 providers with a high or increasing number of Short Stay claims per Area with a request for 25 cases, and all other providers previously identified as having “Major Concerns” in the prior round of review will have a request for 10 cases.

For more of the latest information about the Short Stay reviews from CMS, please click here. If you have specific questions about the change in methodology for the Short Stay reviews, please send an e-mail to Hospital_ODF@cms.hhs.gov.

For your convenience, KEPRO has recently instituted a scheduling program to assist providers with setting up educational sessions.

If you have received an initial determination that noted a Major Concern, please click below to schedule your educational session.

Schedule Today!

In 2015, CMS announced changes to its approach with regard to educating providers and enforcing the Two-Midnight Rule. Specifically, CMS decided to use BFCC-QIOs, rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first line medical reviews of providers who submit claims for inpatient admissions. BFCC-QIOs have a significant history of collaborating with hospitals and other stakeholders to ensure high quality care for beneficiaries.

BFCC-QIO Short Stay reviews focus on making sure doctors and hospitals are following the Part A payment policy for inpatient admission and also provide an educational opportunity for cases that did not meet the benchmark. Recovery Auditor Patient Status reviews will be conducted by the Recovery Auditors, after consultation with CMS, for those hospitals that have consistent trends of high denial rates based on the BFCC-QIO Short Stay review outcomes.

Additional updates will be posted on this webpage, as they become available, and through the KEPRO newsletter, Case Review Connections. Click here to sign up to receive this electronic mailing.

Key elements that providers need to know:

If you have specific questions related to Short Stay Reviews, please call 813-280-8256 x7480.

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