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By Ginger - Site Admin on Tuesday, September 06, 2016 9:09 AM
KEPRO, Kentucky's quality improvement organization (QIO), announced on Friday that the Short Stay reviews will be resuming soon. The organization hopes to receive further details from the Centers for Medicare and Medicaid Services (CMS) this week, and will provide more information at that time about upcoming informational webinars that will be held during the third week of September.
By Ginger - Site Admin on Friday, September 25, 2015 8:22 AM
Important changes will go into effect on October 1, 2015, regarding the Two-Midnight Rule. The Centers for Medicare and Medicaid Services (CMS) is changing its approach with regard to educating providers and enforcing Two-Midnight Short-Stay reviews. Specifically, CMS has decided to use Beneficiary and Family-Centered Care Quality Improvement Organizations (BFCC-QIOs), rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first line medical reviews of providers who submit claims for inpatient admissions.

Kentucky’s BFCC-QIO is KEPRO, which has more information on the changes and action hospitals should take on its website. KEPRO is hosting an informational webinar for hospitals on Wednesday, September 30 at 3:00 p.m. (ET). Each hospital should identify at least one person to participate. There are a limited number of lines available so please register TODAY!...
By Ginger - Site Admin on Thursday, August 20, 2015 8:09 AM
On August 18, the Centers for Medicare and Medicaid Services (CMS) held an Open Door Forum to discuss hospitals and hospital quality. During the forum, CMS addressed short stay policies.

Officials noted that, in conjunction with proposals in the calendar year (CY) 2016 Outpatient Prospective Payment System (OPPS) Proposed Rule, the Agency has extended its probe and educate review period through December 31.Beginning October 1, quality improvement organizations (QIOs) will take over initial reviews of claims for patient status based on current policies. As of January 1, QIOs and recovery audit contractors (RACs) will carry out reviews based on any policies adopted through the OPPS final rule.

CMS said QIOs will conduct reviews and education sessions in a collaborative manner with providers and will only refer cases to recovery audit contractors (RACs) for further review if there is evidence of a pattern of high levels of short stay claims denials, if a hospital does not respond to educational outreach or if there is some potential of fraud or abuse. The Agency acknowledged that there are questions about parameters for review and how referrals will be made and said more information will be forthcoming.

...
By Ginger - Site Admin on Thursday, July 16, 2015 7:38 AM
KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for more than 30 states, including Kentucky. On July 28 from 10:00 – 11:00 a.m. (ET), KEPRO will host a webinar for Kentucky hospitals to discuss their role and answer any questions.

KEPRO will also briefly discuss the recent Centers for Medicare and Medicaid Services (CMS) Outpatient Proposed Rule which would expand their role on the Two-Midnight Rule policy. Specifically, CMS has decided to use QIOs, rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first-line medical reviews of providers who submit claims for inpatient admissions.

For instructions on how to register, visit http://www.new-kyha.com/Portals/5/NewsDocs/KEPROMeetingRegistration.pdf.

If you have any questions, please contact Elizabeth Cobb at KHA (ecobb@kyha.com)....
By Ginger - Site Admin on Tuesday, July 14, 2015 7:45 AM

KEPRO is the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for more than 30 states, including Kentucky. On July 28 from 10:00 – 11:00 a.m. (ET), KEPRO will host a webinar for Kentucky hospitals to discuss their role and answer any questions.

KEPRO will also briefly discuss the recent Centers for Medicare and Medicaid Services (CMS) Outpatient Proposed Rule which would expand their role on the Two-Midnight Rule policy. Specifically, CMS has decided to use QIOs, rather than Medicare Administrative Contractors (MACs) or Recovery Auditors, to conduct the first-line medical reviews of providers who submit claims for inpatient admissions.

KHA will share dial-in information as soon as it becomes available. Please save the date.

If you have any questions, please contact Elizabeth Cobb at KHA (ecobb@kyha.com).

By Ginger - Site Admin on Friday, July 25, 2014 8:15 AM

On July 23, the Centers for Medicare and Medicaid Services (CMS) conducted a webinar to explain changes in the Quality Improvement Organization (QIO) program, as KHA briefly outlined (see article). Many hospitals were unable to join the webinar, so the slides are available at http://www.new-kyha.com/Portals/5/NewsDocs/ProviderCallSlides%2007232014.pdf for your information.

CMS plans to conduct additional webinars/conference calls to repeat the information. KHA will notify you when they are scheduled.

By Ginger - Site Admin on Tuesday, July 22, 2014 9:31 AM
The Centers for Medicare and Medicaid Services (CMS) has awarded new quality improvement organization (QIO) contracts. For the first time, CMS restructured the QIO program by separating the QIO’s case review work from the quality improvement work, and issued separate requests for proposals (RFPs) and contracts for each. Two contracts were awarded to Beneficiary and Family Centered Care QIOs (BFCC-QIO) to perform case reviews, quality of care reviews, diagnosis-related group (DRG) reviews, EMTALA reviews, appropriateness of setting reviews, medical necessity reviews, readmission reviews, Physician Acknowledgment Statement monitoring, appeals and sanctions. KePRO (which previously held the QIO contract for Ohio), was awarded the BFCC-QIO contract for Kentucky as well as 32 other states and the District of Columbia. Kentucky hospitals should have received a letter from KePRO indicating they will begin this work August 1, and advising that hospitals should download, sign and return a Memorandum of Agreement (MOA)...
By Ginger - Site Admin on Friday, July 18, 2014 2:13 PM
On July 18, the Centers for Medicare and Medicaid Services (CMS) awarded additional contracts as part of a restructuring of the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care.

The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs.

QIN-QIO projects will be based in communities, health care facilities and clinical practices. They will drive quality by providing technical assistance, convening learning and action networks for sharing best practices, and collecting and analyzing data for improvement. The U.S. Department of Health and Human Services’ (HHS) National Quality Strategy (NQS) and the CMS Quality Strategy provide the framework for the contracts along with the companion, recommendations and priorities....
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