No. 11

Post-Acute Care Edition
Medical Director's Corner - Ferdinand Richards III, MD
The Centers for Medicare & Medicaid Services (CMS) has released its annual Quality Improvement Organization (QIO) Program Progress Report for 2016, which provides updates on the activities of the QIO Program. In this report are the accomplishments of both the Beneficiary and Family Centered Care QIOs (BFCC-QIOs) and the Quality Innovation Network QIOs (QIN-QIOs).
During 2016, the BFCC-QIOs completed more than 448,200 reviews and saved the Medicare program $20 million processing Higher Weighted Diagnosis-Related Group (HWDRG) reviews. More than 328,800 discharge appeal reviews were completed, resulting in 68,200 beneficiaries not being discharged when they needed continued care. Appeal types include skilled nursing facilities, acute rehabilitation, hospital, and hospice discharges as well as admission denials. BFCC-QIOs performed more than 29,050 quality of care reviews, which identified opportunities for quality improvement in various settings. Then the BFCC-QIOs partnered with the QIN-QIOs to implement more than 730 quality improvement initiatives to address the identified concerns.
QIN-QIOs were successful in achieving meaningful results in the areas of care coordination, diabetes care, and nursing home care. CMS leaders were awarded the Samuel J. Heyman Service to America Medal (SAMMIE) as Federal Employees of the Year for achieving major improvements in hospital patient safety in collaboration with diverse public-private sector partners such as QIOs.
Learn more about the impact of the QIO program in your state.
Bar Codes on Medical Records for Appeals
Reminder: KEPRO has added a bar code to all appeal medical record fax requests sent to healthcare providers and Medicare Advantage health plans. These bar codes directly correlate to the case ID associated with each appeal. KEPRO kindly requests that all providers include the fax request document with this bar code when submitting medical records to KEPRO. If there are multiple medical records or batches of records, please include the fax request document with the bar code as the first sheet of each batch.
Person and Family Engagement
Person and Family Engagement is one of CMS' key initiatives. It emphasizes the importance of patient engagement and patient's voices. Would you be interested in a free webinar for your organization about Person and Family Engagement? If so, please click here  for more information.
Immediate Advocacy Success Story
Immediate Advocacy is an informal process in which KEPRO acts as a liaison for a Medicare beneficiary or his or her representative to quickly resolve a verbal complaint. Below is an example of a KEPRO success story.
A Medicare beneficiary's daughter contacted KEPRO with concerns about her father's care at a rehabilitation facility. She was concerned that he had only had one session of occupational therapy, and he had not been eating because he was afraid staff would not be available to take him to the bathroom. She was also concerned that he was not getting his medications timely, including his pain medication. The daughter requested an intervention by the BFCC-QIO.
The KEPRO Intake Specialist contacted the Administrator at the rehabilitation facility. The Administrator stated that she would speak with the daughter. After the meeting, the Administrator left a message that the concerns had been resolved. The KEPRO Intake Specialist followed up with the daughter to find out that the situation was improving and she was very satisfied with the outcome of the intervention.
Post-Acute FAQs
Q. Is there a form a facility would use to rescind the Notice of Medicare Non-coverage (NOMNC)? How would a facility go about doing this and notifying KEPRO?
A. There is a form attached to the medical record request that allows the facility to note that the NOMNC has been rescinded. It would also need to be noted in the medical record along with documentation for the reason that it was rescinded. If the medical records have already been sent, someone from the facility would need to contact KEPRO.
Q. Is there a notice required for a Medicare patient that is requesting to leave the facility prior to benefits exhausting even though skilled services and coverage remains in effect?
A. It is not required, but it is a good idea to give the NOMNC in case the beneficiary later disputes that he/she requested to leave. Sometimes when a beneficiary gets home and has difficulty, he/she may decide to file a complaint about an inappropriate discharge.
5 Ways for Healthcare Providers to Get Ready for the New Medicare Cards
Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative, CMS will prevent fraud, fight identity theft, and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.  

CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems they use now. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

CMS is committed to helping providers by giving them the tools they need. They want to make this process as easy as possible for patients and staff. Based on feedback from healthcare providers, practice managers, and other stakeholders, CMS is developing capabilities where doctors and other healthcare providers will be able to look up the new MBI through a secure tool at the point of service. To make this change easier, there is a 21-month transition period where all healthcare providers will be able to use either the MBI or the HICN for billing purposes. 


Join us for a BFCC-QIO webinar! We offer three services to Medicare beneficiaries and their families: beneficiary complaints, discharge appeals, and Immediate Advocacy. This webinar will present a basic overview of these services as well as an introduction to some provider-based services.
What: The BFCC-QIO Program
Who: Healthcare providers and stakeholders
When: September 20, 2017, 2 p.m. - 3 p.m. ET
Speakers: Lucia Di Gioia, Outreach Specialist, KEPRO; Lesa Allen-Gaither Outreach Specialist, KEPRO
Publication No. A234-520-8/2017. This material was prepared by KEPRO, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Please do not copy/paste information from Case Review Connections. If you'd like to communicate BFCC-QIO information, please contact KEPRO at