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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
Per MLN Matters, "You may deliver NOMNC to representatives whom the beneficiary has authorized and appointed to act on their behalf during the appeal process. A beneficiary may designate an appointed representative via the Appointment of Representative form.  More
Tips for Success with the Appeals Process

Make sure that:

  • The most current notice is being used, with KEPRO's correct information filled in. Notices that are not correct will be determined to be invalid.
  • 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.

Immediate Advocacy Success Story

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

A beneficiary's wife contacted the BFCC-QIO with concerns that her husband was being denied care from a hospice agency. She had contacted the hospice when her husband was being discharged from the hospital and was in need of hospice services. She was informed that her husband would receive two hours of service per week. She then contacted Medicare to check the type of services that her husband was entitled to receive. Medicare informed her that the provider should call the Medicare Provider Line to inquire about the entitled services. After requesting that the provider contact the Medicare Provider Line, the hospice stated that they would not accept the beneficiary's husband for services.

The Intake Specialist contacted the Compliance Director for hospice and was informed that the beneficiary's wife was seeking services that were outside the scope of the hospice capabilities. She informed the Intake Specialist what services could be provided by their agency. She also stated that the hospice would be willing to reassess the beneficiary and admit him for service. The Intake Specialist then contacted the beneficiary's wife, and she said that she would be contacting the hospice to reschedule an appointment.

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 home health agency, skilled nursing facility, hospice, or comprehensive outpatient rehabilitation facility 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.

Publication No. A234-117-3/2015. 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.