Beneficiary and Family-Centered Care Vendor for Virginia, KEPRO, Seeks Contact Information for Expedited Discharge Appeals

The new Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) contract between CMS and KEPRO (for Virginia) remains a focus for VHCA and our members as implementation issues continue to be worked through (see last week’s CareConnection for additional background).  We have been made aware that residents/facilities have been:

  • unable to get responses from KEPRO, or encountering long waits both on the phone and for a response to their appeal.
  • receiving incorrect information from staff who offer to provide responses, documentation or resolution.
  • left in the dark for as many as 7-14 days with no response.
  • repeatedly required to resend lost or missing documents.

In particular, the issue of expedited appeal decisions after issuance of the Notice of Medicare Non-Coverage (NOMNC) not being rendered timely by the QIO is a major concern.  This has obvious implications for both facilities and patients in terms of potential financial liability for services.  VHCA has elevated this issue to the American Health Care Association (AHCA), and it appears the issues are not unique to Virginia.  AHCA is attempting to work with CMS and KEPRO in seeking a resolution.  In the meantime, KEPRO has requested facilities to provide relevant contact information in order to help expedite issues (download form here).

In response to AHCA, CMS has indicated it is working closely with the QIOs (KEPRO for Virginia) to reach resolution of the issues experienced in the field.  CMS intends to hold a meeting for the provider community so everyone can hear the identified issues and mitigation strategies.  In the meantime, the designated contact for KEPRO is Gayle Smith or 330.323.2188.