Medicare Appeals Backlog Cleared, According to KEPRO

As previously reported in this publication, the transition to KEPRO under the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) contract had led to multiple concerns from the field primarily around the timeliness of Notice of Medicare Non-Coverage (NOMNC) appeals and the obvious implications for both facilities and patients in terms of potential financial liability for services.  KEPRO reported significant backlogs in appeals processing, and VHCA, through the the AHCA (American Health Care Association), was working with the Centers for Medicare and Medicaid Services (CMS) and KEPRO to rectify the situation.

In response to our inquiry to KEPRO for a status update on the backlog, Gayle Smith, KEPRO Vice President with responsibility for the region including Virginia, indicated on September 10th, “Yes, our backlog has been cleared. We are processing appeals received yesterday, 9/9 and today 9/10 (assuming all required information is present).”  

Ms. Smith recommended that if additional questions/concerns persist, members can get information form the KEPRO website, call her directly (330.323.2188) or call Chery Cook, Program Director for area 2 (813.280.8256 x7201).