Changes to Case Review Services

In further QIO news, beneficiary protection has also changed. Two companies were awarded contracts to manage beneficiary protection.  As part of its changes to the QIO Program, CMS is separating case review activities from quality improvement efforts. To avoid potential conflicts of interest and achieve cost efficiencies, CMS has awarded two companies, Livanta, LLC and KePRO, with contracts to support case review for the entire country.  Beginning August 1, 2014, KePRO will be the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) authorized by the Centers for Medicare & Medicaid Services (CMS) to review medical services provided to Medicare beneficiaries in Areas 2, 3 and 4, which includes Virginia. Therefore, as of August 1, VHQC will no longer manage case review or beneficiary complaints.

We have received several inquiries about completing the Memorandum of Agreement (MOA) and those entities that are required to have one.   According to a Memorandum of Agreement (MOA) Frequently Asked Questions, SNFs are among those required to sign and return an executed MOA to KEPRO if they intend to participate or continue to participate in the Medicare program. The MOA is available online here.   Members can contact Rita Bowling, Program Director, at 216-447-9604 ext. 5759 or by email at rita.bowling@hcqis.org with questions about the MOA.  

KePRO will have primary responsibility for conducting case review functions, such as complaint reviews, quality of care reviews, discharge appeals, higher weighted diagnostic related group (DRG) requests and Emergency Medical Treatment and Active Labor Act (EMTALA) reviews. After August 1, all case review communications should be sent to KePRO at the following:

KePRO
Website: www.kepro.com      
Address: 5201 W. Kennedy Blvd., Suite 900 Tampa, FL 33609
Toll-free phone: 844-455-8708
Fax: 844-834-7129