Ohio KEPRO (KEPRO) was recently awarded three CMS Beneficiary and Family-Centered Care (BFCC) contracts that encompasses 34 states across the nation.
States affected are: District of Columbia, Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, West Virginia, Alabama, Arkansas, Colorado, Kentucky, Louisiana, Mississippi, Montana, North Dakota, New Mexico, Oklahoma, South Dakota, Tennessee, Texas, Utah, Wyoming, Iowa, Illinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio and Wisconsin.
The Centers for Medicare and Medicaid Services (CMS) recently began restructuring the Quality Improvement Organization (QIO) Program to improve patient care, health outcomes, and save taxpayer resources. This first phase of the restructuring awarded five areas of Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs.
QIOs historically have provided numerous quality improvement functions, including providing an infrastructure for national quality improvement initiatives across the continuum of care; today’s announcement highlights CMS’ efforts to restructure the QIO Program to gain efficiencies, to eliminate any perceived conflicts of interest, and to better address the needs of Medicare beneficiaries using BFCC QIOs to focus on providing patients a voice through conducting quality of care reviews, discharge and termination of service appeals, and other areas of required review in various provider settings.
KEPRO will be providing review of some or all of the professional activities of providers and practitioners in the QIO areas to Medicare beneficiaries; such reviews are for purposes of determining whether services are or were reasonable and medically necessary, whether the quality of the services meets professionally recognized standards of care, and, for inpatient services, whether the proposed services could be effectively provided more economically on an outpatient basis or in a different type of inpatient facility. These reviews are integral to the determination whether items and services should be payable under the Medicare program. “We are pleased and honored that CMS has selected KEPRO as the prime vendor to lead this initiative. KEPRO has been serving as a Quality Improvement Organization for over 28 years and we are excited to continue and expand our partnership with CMS”, stated Joseph Dougher, KEPRO’s President and CEO.
CMS and KEPRO will introduce the program changes with the beginning of its five year, 11th Statement of Work – the QIO contracts cycle – on Aug. 1, 2014.
If you are in any of these states listed above you will need to revise your NOMNC form to include Kepro as the QIO and discard any existing forms.
The phone number you will need to list is 1-800-385-5080.
If you receive a letter from Kepro you need to respond immediately.