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Welcome to Case Review Connections!
Case Review Connections has been published to provide you with information from KEPRO, your Beneficiary and Family Centerd Care Quality Improvement Organization (BFCC-QIO).  We welcome your feedback at to learn more about topics that interest you.
On August 1, 2014, KEPRO became the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for three of the five regions that the Centers for Medicare & Medicaid Services (CMS) designated in the United States and surrounding territories. We would like to thank both providers and CMS for their support during the recent transition from state Quality Improvement Organizations to the regional BFCC-QIO. With your support, we have made a successful transition and look forward to serving as your BFCC-QIO.
Telephonic Notification
If you are having trouble complying with the requirement to notify the beneficiary's representative, because that person is not available to acknowledge receipt of the notice, what are your options? Hospitals are required to develop procedures to use when the beneficiary is incapable of receiving or incompetent to receive the notice, and the hospital cannot obtain the signature of the beneficiary's representative through direct personal contact. More
Tips for Success with the Appeals Process
Make sure that:
  • The Important Message from Medicare is issued both at admission and two days prior to discharge. Remember that it is not issued if the patient is in observation.
  • KEPRO's information and phone number have been updated on your facility's copy of the Important Message from Medicare.
  • Weekend staff is familiar with the BFCC-QIO appeal process.
  • The BFCC-QIO has the correct contact information for your facility, both for weekdays and weekends/holidays.
Case Lookup Feature


KEPRO has added a new feature to the website, Providers and beneficiaries can now access appeal case status information directly from the website without having to call the BFCC-QIO. Just put in the case number and state, and a status update will appear. When the case is complete, the decision will also be listed along with the liability date. This new feature gives providers and beneficiaries easy access to the most up-to-date information. 

Physician Acknowledgement Process
At some time in the last year, your hospital may have received a letter from your state Quality Improvement Organization (QIO) outlining the process and requirements for the Physician Acknowledgement Monitoring Process. As the BFCC-QIO, we are required by CMS to monitor prospective payment system (PPS) hospital compliance with securing physician acknowledgment statements for newly appointed physicians. We conduct this monitoring on an annual basis.  More

Immediate Advocacy Success Story

Immediate Advocacy - an informal process in which the BFCC-QIO acts as a liaison for the Medicare beneficiary to quickly resolve an oral complaint.

A Medicare beneficiary's daughter contacted the BFCC-QIO with concerns about her father. He was in the hospital and had a fever for the last three days. She had not been able to meet with the physician and was concerned that she had not received any information about the plan of care for her father. She was concerned that the medical staff was not taking her father's condition seriously.

The Intake Specialist was able to set up a conference call between the Patient Relations department and the daughter. The daughter was able to express her concerns regarding the lack of communication. The Patient Relations coordinator agreed to find out which hospitalist was assigned to her father and have him/her call the daughter.

The Intake Specialist received a call back from the Patient Relations coordinator. The daughter was able to speak with the hospitalist, share her concerns, and have her questions answered.

The Beneficiary Complaint Process and Quality Improvement Activities (QIA)

The BFCC-QIO is still responsible for the beneficiary complaint process. Beneficiaries and/or their representatives can file a complaint against a hospital related to the care that was received. The BFCC-QIO will do the quality of care review. If quality of care concerns are identified and a quality improvement activity (QIA) is needed, the Quality Innovation Network Quality Improvement Organization (QIN-QIO) will take over the QIA portion. Your facility will receive correspondence from your state QIN-QIO related to the QIA. The full original review process will still be completed by the BFCC-QIO.

Coding Corner

When providers receive a request from the BFCC-QIO related to a query or related to the 72-hour rule, please provide the query sheet and the clinical documentation combined, per the 72-hour rule, when the medical record is sent. This will prevent further delay with the review.

For the latest information related to ICD-10, visit

If you have questions related to the Higher Weighted Diagnosis Related Group (HWDRG) process, please contact Steve Dicksen at

Publication No. A234-116-3/2015. 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 Serivces. The contents presented do not necessarily reflect CMS policy.